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Published on: September 29, 2018
The impact of a quality management program for patients undergoing head and neck resection with free-flap
Joseph C Dort1,2,3,4, Khara M Sauro5,6, Shamir Chandarana7,5,8
1Section of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada. jdort@ucalgary.ca.
Background:
Care pathways (CPs) are helpful in reducing unwanted variation in clinical care. Most studies of CPs show they improve clinical outcomes but there is little known about the long-term impact of CPs as part of a sustained quality management program. Head and neck (HN) surgery with free flap reconstruction is complex, time-consuming and expensive. Complications are common and therefore CPs applied to this patient population are the focus of this paper. In this paper we report outcomes from a 9 year experience designing and using CPs in the management of patients undergoing major head and neck resection with free flap reconstruction.
Methods:
The Calgary quality management program and CP design is described the accompanying article. Data from CP managed patients undergoing major HN surgery were prospectively collected and compared to a baseline cohort of patients managed with standard care. Data were retrospectively analyzed and intergroup comparisons were made.
Results:
Mobilization, decannulation time and hospital length of stay were significantly improved in pathway-managed patients (p = 0.001). Trend analysis showed sustained improvement in key performance indicators including complications. Return to the OR, primarily to assess a compromised flap, is increasing.
Conclusions:
Care pathways when deployed as part of an ongoing quality management program are associated with improved clinical outcomes in this complex group of patients.
