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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Susanne Hughes, RN1, Rhonda Clark, PhD1, Myra L. Barnes, MPH2, Louise Lawson, PhD3, and John Pestian, PhD4. (1) Clinical Outcomes, Research, and Epidemiology, Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA 23507, 757-668-8256, shughes@chkd.com, (2) Clinical Outcomes, Research, and Epidemiology, Children's Hospital of the Kings Daughters , Norfolk,VA, 601 Children's Lane, Norfolk, VA 23507, (3) Children's Hospital of The King's Daughters, Center for Pediatric Research, 855 West Brambleton Ave, Norfolk, VA 23510, (4) Pediatric Informatics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH 45229
Background: Clinical pathways (CP) use evidence-based care strategies to achieve quality patient care. Successful pathways result in high quality and cost-effective care. Objective: To evaluate the ability of an inguinal orchiopexy pathway to reduce costs and times for anesthesia, surgery, and stays in the Post Anesthesia Care Unit (PACU) and Step-down PACU. Design/Methods: The pathway was developed and implemented in an urban children’s hospital. A pilot study of the pathway and a 5-year follow-up evaluation were completed. Eighteen pilot, pathway, and control patients matched on age and race were randomly sampled for each evaluation. Analysis of variance and t-tests analyzed cost, charges, and the mean anesthesia, procedure, PACU and Step-down PACU times. Fisher’s Exact test analyzed differences in the proportion of patients in each group meeting benchmark times for each outcome. Results: Mean anesthesia time was significantly reduced by 13% for pilot patients (p=0.003) and 10% for follow-up patients (p<0.001). Mean procedure time was significantly reduced by 21% for pilot patients (p<0.001) and 8% for follow-up patients (p<0.001). Step-down PACU times were significantly reduced by 33% for follow-up patients compared to controls (p=0.032). Direct costs were significantly decreased by 16% for pilot patients (p<0.001) and 10% for follow-up patients (p<0.0001). Surgical wound infections or 72-hour re-admissions or Emergency Department visits were not reported for any of the 3 groups. Conclusions: The inguinal orchiopexy pathway has maintained and improved outcomes and cost reductions over time. It reduced anesthesia, procedure and Step-down PACU times while maintaining a high quality of care.
Learning Objectives: "At the conclusion of the session, the participant (learner) in this session will be able to
Keywords: Quality Improvement, Outcome Measures
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.