8/7/2019 utiliyi of clinical pathway and prospective case management to achieve cost and hospital stay reduction

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Util ity of cl inical pathway and prospectivecase management to achieve cost andhospital stay reduction for aorticaneurysm surgery at a tertiarycare hospitalSatish C. Muluk , MD , Lisa Painter, MS N, Saba Sile, BS,Robert Y. Rhee, MD, Michel S. Makaroun, MD, David L. Steed, MD,and Marshall W. Webster, M D, Pittsburgh, Pa.Purpose: W e r ev iewed our exper ience wi th a cl in ica l pa th way ins t i tu te d in De cemb er 1 993f o r a ll n o n u r g e n t a b d o m i n a l a o r t i c a n e u r y s m ( A A A ) s ur g e r y .Methods: W e a n a l y z ed a r e fe r en c e g r o u p o f 4 9 c o n s e c ut i v e p r e - p a t h w a y A A A p a t ie n t s( g r o u p I ) a n d t h e 4 4 p a t i e n ts e n r o l l e d i n t h e f i rs t y e a r o f t h e p a t h w a y ( g r o u p I I ) . O n t h ebas i s o f the in te r im r ev iew of da ta co l lec ted dur ing the f i r s t yea r , pa thwa y modi f ica t ionswer e made , and 3 4 pa t ien t s enr o l led a f te r these modi f ica t ions ( g r oup I I I ) wer e a l soana lyzed .Results: C o m p a r i s o n o f g r o u p s I a n d I I s h o w e d t h a t i n s t i t u t i o n o f t h e p a t h w a y r e s u l t ed i na mar g ina l ly s ign i f ican t r edu c t ion in mean char ges of 14 .7% ( p -- 0 . 09) , and a s l igh t f a ll inmean length of s tay ( LOS) ( 13 .8 vs 13 .1 days , NS) a nd mo r ta l i ty r a te ( 4 .1% vs 2 .3%, NS) .For g r ou p I I , a s ign i f ican t cor r e la te ( p < 0 .05) of inc reased char ges was f lu id over load asd iagnosed by ches t r ad iogr aph . This r ecogni t ion led to ac t ive e f f or t s to r educe pe r ioper -a t iv e f lu i d a d m i n i s t ra t i o n . C o m p a r i s o n o f g r o u p s I I ~ n d I I I r e v e a le d t h a t t h e p r a c t ic emodi f ica t ion s led to mar ke d r ed uc t io n in the inc idence of f lu id over load ( 73% vs 24%; p