title: Clinical Pathway Implementation Improves Efficiency of Care in a Maxillofacial Head and Neck Surgery Unit.
abstract: OBJECTIVE
  Clinical pathways have become an important and simple method of improving patient outcomes and decreasing health care resource usage. The purpose of this study was to evaluate early outcomes associated with the implementation of a clinical pathway in a maxillofacial head and neck surgery unit.
  
  
  METHODS
  This investigation is a retrospective cohort study of patients who underwent microvascular reconstruction of the head and neck from January 1, 2014 through December 31, 2014. Continuous variables were compared among 4 groups using analysis of variance or Kruskal-Wallis test, and categorical variables were compared using χ2test or Fisher exact test where appropriate. The primary predictor variable was use of the clinical pathway. Groups included patients treated by surgeon A during periods before and after implementation of a postoperative clinical pathway. Two groups treated by surgeon B also were evaluated during the same periods and served as external controls. Each period covered a span of 6 months. Outcome variables across groups were evaluated, including length-of-stay metrics, infection rates, transfers to the intensive care unit, and unplanned return to the operating room.
  
  
  RESULTS
  Sixty-six patients who underwent microvascular head and neck reconstruction were included. There was a significant decrease in the average length of stay (P = .0364) and an increase in the rate of discharge within 7 days (P = .0416) in the group treated with the clinical pathway. Other outcomes, including infection rate, transfer to the intensive care unit, and unanticipated return to the operating room, showed no relevant difference among groups.
  
  
  CONCLUSIONS
  The results of this study suggest that implementation of a clinical pathway can be beneficial for efficient management of postoperative care in the setting of microvascular head and neck reconstruction. More predictable and shorter lengths of stay are achievable and the clinical pathway serves as a valuable means of improving communication of the clinical care team.
authors.affiliation: Instructor, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN. Electronic address: arce.kevin@mayo.edu.
authors.forename: Jacob G
authors.initials: JG
authors.lastname: Yetzer
authors.affiliation: Associate Professor and Associate Chief, Division of Head and Neck Surgery, University of Florida-Jacksonville, Jacksonville, FL.
authors.forename: Phillip
authors.initials: P
authors.lastname: Pirgousis
authors.affiliation: Biostatistician, Division of Biostatistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Li
authors.affiliation: Associate Professor; Chief, Division of Head and Neck Surgery; Associate Chair, Department of Oral and Maxillofacial Surgery, University of Florida-Jacksonville, Jacksonville, FL.
authors.forename: Rui
authors.initials: R
authors.lastname: Fernandes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways / Q000458:organization & administration; D017598:Efficiency, Organizational; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016730:Program Development; D058996:Quality Improvement / Q000458:organization & administration; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013515:Surgery, Oral / Q000458:organization & administration* / Q000592:standards; D014656:Vascular Surgical Procedures / Q000379:methods / Q000458:organization & administration; D055815:Young Adult