Compliance of Clinical Pathways in Elective Laparoscopic Cholecystectomy: Evaluation of Different Implementation Methods
Study Details
Study Description
Brief Summary
Compliance to the clinical pathway, postoperative complication and total cost of the hospitalisation of patients undergoing elective cholecystectomy for symptomatic cholecystolithiasis were collected over two different periods: using a clinical pathway in form of a paper based check-list (group 1, n=118) or a clinical pathway integrated into the paper based medical treatment and nursing documentation (group 2, n=123). Outcome measures were compliance of the clinical pathway and total costs per case.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Data of patients undergoing elective cholecystectomy for symptomatic cholecystolithiasis were collected over two different periods: a clinical pathway in form of a paper based check-list (check-list group, n=118, or in form of a clinical pathway integrated into the paper based medical treatment and nursing documentation (integrated clinical pathway group, n=123. A standardized clinical pathway for elective laparoscopic cholecystectomy in form of a check list was initially established in 2008 and evaluated during a 6-month period (August 2011 until January 2012) at the University of Tuebingen. The integrated clinical pathway was evaluated during a 6-month period after an introduction phase of 2 months (November 2012 until April 2013). The contents of both clinical pathways were identical, especially concerning the standardization of perioperative fluid management, perioperative monitoring, nutrition, analgesia, reserve medications, preoperative and postoperative examinations, detailed laboratory blood testing, nursing standards and planned discharge.
Primary outcome measure was the compliance to the clinical pathway defined as an adherence of more than 80% to the presetted pathway items.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| check list clinical pathway using a paper based check-list |
Other: clinical pathway
implementation of a standardized clinical pathway
|
| integrated clinical pathway clinical pathway in form of a clinical pathway integrated into the paper based medical treatment and nursing documentation |
Other: clinical pathway
implementation of a standardized clinical pathway
|
Outcome Measures
Primary Outcome Measures
- compliance to clinical pathway [time period which is covered by the clinical pathway beginning from preclinical check up until final discharge after cholecystctomy (usually a time frame of 7-14 days)]
Compliance to clinical pathway defined as an adherence of more than 80% to the presetted pathway items as reported on a paper based check-list
Secondary Outcome Measures
- complication [30 days complication rate]
Complications assessed according to Clavien classification 30 days postoperative
- total cost [total cost of the hospitalization covering the period from preclinical check up until final discharge after cholecystctomy (usually a time frame of 7-14 days)]
total costs per case covering the period from preclinical check up until final and discharge after cholecystctomy (€) were assessed using our prospective. electronic patient and quality assessment data base. Costs were calculated according to our internal transfer prices.
Eligibility Criteria
Criteria
Inclusion Criteria:
- patients undergoing elective laparoscopic cholecystectomy
Exclusion Criteria:
-
emergency procedures
-
conversion to open cholecystectomy
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- University Hospital Tuebingen
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- ICP 001