[Integral management of the process of laparoscopic cholecystectomy]

One of the most important objectives of public healthcare services is to guarantee integral healthcare to patients; activity is currently focussed on process management. Analysis of a "key" process could have health, social and economic effects if measures to improve the results are designed. The aim of the present study was to evaluate the process of laparoscopic cholecystectomy in our hospital in order to determine its strong and weak points.

We performed a prospective observational study of the laparoscopic cholecystectomy (LC) process in the Jarrio Hospital between January 2001 and December 2002. A working group was formed and a process flowchart was designed by consensus. The different steps of the process were evaluated through the main indicators of quality: accessibility, efficiency, and effectiveness, including cost, the convalescence period, and patient satisfaction. The results were compared with the standards defined by the Andalusian Health Council, bibliographic sources, and hospital commissions. The statistical analysis was performed with 95% confidence intervals of the main results.

A series of 86 patients who underwent LC was evaluated. The results for accessibility showed wide variability in delays for specialist consultations, the waiting list for surgery, and urgent diagnostic tests, often exceeding the standards. The laparoscopic approach was more frequent than open cholecystectomy; morbidity and mortality with LC were below the reference standards and compliance with established prophylaxis protocols was close. The efficiency markers showed that the length of hospital stay for elective LC was close to the standard; however, for cholecystitis preoperative length of stay was longer than the standard. Overall patient satisfaction with medical care and non-medical services was high.

Quality analysis of a process allowed us to identify strong points such as the high rate of laparoscopic cholecystectomy -showing good effectiveness and efficiency- the quality of informed consent, and patient satisfaction. Required improvements consisted of shortening preoperative length of stay in acute cholecystitis and waiting lists, informing patients about the length of the convalesce period, eliminating routine type and screen, and admitting patients on the day of surgery.