Effects of implementation of clinical pathways on care among patients undergoing ophthalmic surgery

Abstract

Abstract: : Purpose: To evaluate actual use of clinical pathways and variances, and compare the length of hospital stay for surgery. Methods: We introduced clinical pathways for the medical team and the patients on September 1, 2001, and designed eight types of medical team clinical pathways for cataract, glaucoma, combined cataract and glaucoma surgery, vitreous surgery for macular hole, proliferative diabetic retinopathy, retinal detachment and other vitreous surgeries, and scleral buckling for retinal detachment. We have performed 102 phacoemulsification and IOL implantation, 19 glaucoma or combined glaucoma and phacoemulsification/IOL, and 69 retina–vitreous surgeries for 1 year from February 2002. We compared the length of hospital stay before and after clinical pathway implementation. Results: We used the clinical pathways in 102 (100 %) of phacoemulsification/IOL, 17 (89.5 %) of glaucoma, and 69 (100%) of retina–vitreous surgery. The variances occurred in 37 eyes of (36.3%) 102 phacoemulsification/IOL, 6 eyes (31.6%) of glaucoma, and 24 eyes (34.2%) of retina–vitreous surgery. The length of hospital stay shortened in phacoemulsification/IOL after clinical pathway implementation from 7.8 ± 3.3 to 6.7 ± 2.5 days, especially significantly shortened in glaucoma form 16.4 ± 5.0 to 12.6 ± 3.3 days (Mann–Whitney U test; P=0.032), and retina–vitreous surgery form 22.8 ± 11.1 to 17.9 ± 6.2 days (P=0.001). Conclusions: The clinical pathways were successfully implemented on care of patients undergoing ophthalmic surgery, and resulted in reduction of hospital stay.

Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower • clinical (human) or epidemiologic studies: outcomes/complications