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The sustained impact of an evidenced-based clinical pathway for acute appendicitis
Brad W Warner1, Kate A Rich, Harry Atherton
1Division of Pediatric Surgery, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
Insights
An evidence-based clinical pathway for pediatric appendicitis improved outcomes like reduced hospital stays and costs. However, sustained benefits varied, suggesting ongoing monitoring and education are crucial for long-term impact.
Area of Science:
- Pediatric Surgery
- Clinical Pathway Implementation
- Healthcare Management
Background:
- Appendicitis is a common pediatric surgical issue with inconsistent diagnostic and postoperative care.
- Variability in practice necessitates standardized approaches for improved patient outcomes and resource utilization.
Purpose of the Study:
- To assess the long-term sustainability of an evidence-based clinical pathway for pediatric appendicitis.
- To evaluate whether the initial benefits of the pathway were maintained beyond the implementation phase.
Main Methods:
- Implementation of an evidence-based clinical pathway for pediatric appendicitis.
- Analysis of key outcome parameters, including hospital cost, length of stay, and laboratory test utilization.
- Longitudinal assessment of pathway effectiveness and sustainability.
Main Results:
- The clinical pathway initially led to reduced hospital costs, shorter hospital stays, and fewer unnecessary laboratory tests.
- Several, but not all, of these favorable outcomes were sustained over the long term.
- Data indicate a mixed sustainability of benefits from the appendicitis clinical pathway.
Conclusions:
- The appendicitis clinical pathway demonstrates sustained positive effects in some areas but not all.
- Continuous pathway compliance monitoring and staff education are recommended for enhanced long-term impact.
- Identifying dedicated pathway leadership may further improve the sustainability and effectiveness of the guidelines.
Abstract:
Appendicitis is a frequent pediatric surgical condition for which there is great variability among practitioners regarding diagnosis and postoperative management. With this in mind, the authors designed and implemented an evidence-based appendicitis clinical pathway at their institution. Establishment of the pathway resulted in decreased hospital cost, reduced hospital stay, and fewer unnecessary laboratory tests. The purpose of the current study was to determine the sustainability of the pathway beyond its initial implementation phase. The authors showed that several, but not all, favorable outcomes of the pathway were sustained. These data suggest that a clinical pathway for appendicitis at the authors' institution results in sustained beneficial effects in some but not all outcome parameters. Ongoing monitoring of pathway compliance, continued education of practitioners and nursing personnel, and identification of key pathway team member(s) responsible for the pathway system might result in a greater long-term impact of these guidelines.