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An evidenced-based clinical pathway for acute appendicitis decreases hospital duration and cost
B W Warner1, R M Kulick, M M Stoops
1Division of Pediatric Surgery, Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH 45229, USA.
Insights
Implementing an evidence-based clinical pathway for acute appendicitis in children reduced hospitalization duration and costs. This approach improved patient care without compromising diagnosis or treatment outcomes.
Area of Science:
- Pediatric Surgery
- Healthcare Management
- Clinical Pathways
Background:
- Appendicitis is the most frequent surgical emergency in pediatric patients.
- Effective management strategies are crucial for optimizing outcomes and resource utilization.
Purpose of the Study:
- To evaluate the impact of an evidence-based clinical pathway for acute appendicitis.
- To assess effects on patient care, hospital costs, and home care expenses in a pediatric institution.
Main Methods:
- Prospective analysis of an appendicitis clinical pathway implemented from June to November 1996.
- Comparison with historical control patients from June to November 1994.
Main Results:
- Pathway patients showed similar rates of negative appendectomy and perforation compared to controls.
- Non-perforated appendicitis pathway patients had earlier discharge (67% vs 48%) and lower costs ($3,638 vs $4,095).
- Perforated appendicitis pathway patients experienced shorter hospitalizations (113 vs 185 hours) and reduced costs ($7,823 vs $11,175).
Conclusions:
- An evidence-based appendicitis pathway effectively reduced hospitalization duration and costs.
- The pathway did not adversely affect diagnostic accuracy or therapeutic effectiveness.
- Clinical pathways offer a valuable tool for cost reduction in surgical care without compromising patient outcomes.
Background/Purpose:
In the pediatric population, appendicitis remains the most common surgical emergency encountered. The purpose of this study was to determine the impact of an evidence-based clinical pathway for acute appendicitis on patient care as well as hospital and home care costs at the authors' pediatric institution.
Methods:
A prospective evaluation was conducted of an appendicitis clinical pathway (June 1996 through November 1996) compared with historical control patients (June 1994 through November 1994) not cared for by the pathway.
Results:
Data (average +/- SD) for 120 pathway (P) patients were compared with 122 control (C) patients. Age (11.5 +/- 3.6 years for C v 11.2 +/- 3.9 years for P), rates of negative appendectomy (12.3% for C v 9.2% for P) and perforation (26.2% for C v 18.3% for P) were similar. Pathway patients with nonperforated appendicitis were more often discharged from the hospital within 24 hours (48% for C v 67% for P; P = .014) with lower hospital costs ($4,095 +/- $1,280 for C v $3,638 +/- $1,633 for P; P = .001). Pathway patients with perforated appendicitis had shorter hospitalization (185.2 +/- 59 hours for C v 113 +/- 44 hours for P; P = .0001) and lower hospital costs ($11,175 +/- $3,893 for C v $7,823 +/- $2,366 for P; P = .0001).
Conclusion:
An evidence-based appendicitis pathway decreased duration of hospitalization and cost without adversely affecting diagnosis or therapy. Clinical pathways for surgical diagnoses may prove useful as a means to minimize costs without compromising patient care.