title: Compliance of Clinical Pathways in Elective Laparoscopic Cholecystectomy: Evaluation of Different Implementation Methods.
abstract: Clinical pathways aim to standardize perioperative and postoperative care of surgical procedures and are shown to result in a significant optimization associated with cost reduction. The aim of this study was to establish the impact of two different implementations forms of clinical pathways on the pathway compliance and resulting costs.
  
  
  
  Data of patients undergoing elective cholecystectomy for symptomatic cholecystolithiasis were collected over two different periods: using a clinical pathway in the form of a paper-based checklist, or a clinical pathway integrated into the paper-based medical treatment and nursing documentation. Outcome measures were compliance of the clinical pathway and total costs per case.
  
  
  
  The compliance was significantly higher using integrated pathways compared to paper-based checklists (n = 117 of 123, 95 % vs 54 of 118, 46 %; p < 0.001). Mean total costs (€2206 vs €2458, p = 0.027) and length of hospital stay (2.13 vs 2.77 days, p < 0.001) were significantly reduced by the integrated clinical pathway compared to checklists. Further, the variation of costs per case and variation of length of hospital stay were significantly smaller with integrated clinical pathway (±€440 vs ±€538, p = 0.039 and ±0.53 vs ±0.68 days, p < 0.001, respectively). No difference regarding postoperative complication was observed (n = 3 vs. 4 events; p = 0.67).
  
  
  
  Integrated clinical pathways display a significant higher compliance compared to checklists resulting in reduced total costs, shorter hospital stay and a smaller variation of cost, making it a useful tool in process controlling and planning.
authors.affiliation: Department of Quality Management, Medical and Business Development, Tuebingen University Hospital, Tübingen, Germany.|Division of Economics and Management of Social Services, within the Institute of Health Care and Public Management, Hohenheim University, Stuttgart, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Holderried
authors.affiliation: Division of Economics and Management of Social Services, within the Institute of Health Care and Public Management, Hohenheim University, Stuttgart, Germany.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hummel
authors.affiliation: Clinic for Visceral, General and Transplant Surgery, Tuebingen University Hospital, Waldhörnlestrasse 22, 72076, Tübingen, Germany.
authors.forename: Claudius
authors.initials: C
authors.lastname: Falch
authors.affiliation: Clinic for Visceral, General and Transplant Surgery, Tuebingen University Hospital, Waldhörnlestrasse 22, 72076, Tübingen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kirschniak
authors.affiliation: Clinic for Visceral, General and Transplant Surgery, Tuebingen University Hospital, Waldhörnlestrasse 22, 72076, Tübingen, Germany.
authors.forename: Alfred
authors.initials: A
authors.lastname: Koenigsrainer
authors.affiliation: Division of Economics and Management of Social Services, within the Institute of Health Care and Public Management, Hohenheim University, Stuttgart, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ernst
authors.affiliation: Clinic for Visceral, General and Transplant Surgery, Tuebingen University Hospital, Waldhörnlestrasse 22, 72076, Tübingen, Germany. sven.mueller@med.uni-tuebingen.de.|Division of Economics and Management of Social Services, within the Institute of Health Care and Public Management, Hohenheim University, Stuttgart, Germany. sven.mueller@med.uni-tuebingen.de.
authors.forename: Sven
authors.initials: S
authors.lastname: Muller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D019091:Critical Pathways; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D055815:Young Adult