J Gastric Cancer.  2012 Jun;12(2):126-131.

The Impact of an Increased Application of Critical Pathway for Gastrectomy on the Length of Stay and Cost

• Seo HS
• Song KY
• Jeon HM
• Park CH

Abstract

PURPOSE
We developed a standardized critical pathway for gastric cancer surgery and then determined the increase of application, which resulted in an improvement in terms of measurable indices, such as hospital stay and cost.
MATERIALS AND METHODS
A critical pathway was revised and used widely from the 2nd quarter of 2009. We collected clinical data, such as length of stay and complication rate, as clinical indices of quality prospectively. The total cost paid at the patient's discharge, as well as the daily hospital income, were calculated and compared by each quarter from January 2008 to December 2009.
RESULTS
The application rate of critical pathway was 11.8% and 87.8% in 2008 and 2009, respectively. There were no perioperative deaths. There was no difference in the complication rates between 2008 and 2009 (P=0.45). However, the mean length of stay was significantly different between the 2 years (P<0.05). Although the total cost was not different, the daily hospital income was significantly higher in the latter year (P<0.05).
CONCLUSIONS
An increase in the application of critical pathway for gastrectomy resulted in significant decreases in length of stay and increases in the daily hospital income without a compromise on the clinical indices.

Keyword

Critical pathway; Gastrectomy; Clinical index; Length of stay; Cost

MeSH Terms

Critical Pathways
Gastrectomy
Length of Stay
Prospective Studies
Stomach Neoplasms

Figure

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  Fig. 1 Roles of the clinical nurse specialist in each step of critical pathway. NPO = not per oral; OP-CP = outpatient critical pathway; IP-CP = inpatient critical pathway.

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  Fig. 2 Mean length of stay in each quarter (Q) period. Solid line is for total gastrectomy and dotted line is for subtotal gastrectomy.

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  Fig. 3 Total and daily paid cost in each quarter (Q) period. (A) Total cost, (B) daily hospital income. Solid line is for total gastrectomy and dotted line is for subtotal gastrectomy. One US dollar stands for 1,100 Korean Won (KRW) in February of 2011.

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