[Attempt to introduce critical paths at a university hospital]

In Japan there is a possibility that diagnosis related group/prospective payment system (DRG/PPS) will be introduced as one means to decrease medical expenses in the future. Recently, measures to improve medical services, including approaches to improving medical care represented by evidence based medicine (EBM) and disclosure of medical information including clinical records, have been seen. The authors department is attempting to introduce clinical paths as one tool to cope with such changes in medical care circumstances. Using the tabulations of patients over the past year and major diagnostic classification (MDC) with the Japanese edition of DRG/PPS serving as a guide, we have prepared critical paths for ten diagnosis and treatment groups consisting of sudden deafness, tonsillectomy, laryngo-microsurgery, endoscopic sinus surgery, tympanoplasty, removal of parotid gland tumor, neck dissection, total laryngectomy, total pharyngo-laryngectomy and operation for tongue-oropharyngeal cancer. We report herein on the present status of the introduction of these critical paths at our department.