Study On Clinical Pathways And Continuous Quality Improvement In Cardiac Surgery

Objective:Clinical pathway(CP)is known widely as an effective way to improve the quality of the medical care in the hospital.With the gradually sophisticated development of the work,the comparison of the quality improvement between the patients admitted and not admitted of clinical pathways has already not been the key study anymore.How to improve the medial care of the patients under the basis of continuous quality improvement within the clinical pathway is another challenge we are facing.The present study was designed to explore the effectiveness of the implementation of clinical pathways on the quality improvement of the results of three cardiac surgeries from a three-class A cardiovascular hospital in Tianjin China,especially the two evaluation indicators of average length of stay and average cost in hospital,to discuss about the effectiveness of its implementation on cardiac surgery and finally to provide the possible references and basis for the management work of clinical pathway.Methods:Firstly,domestic and oversea literature analysis research was used to review the history,characteristics as well as the controversial problems etc.during the development of CP in order to understand the latest conditions of its application,especially in the field of cardiac surgery.Secondly,the data for admittance,admittance rate,length of stay in hospital and cost in hospital in the last five years(from January 1st,2012-December 31 st,2016)were collected from a three-class A cardiovascular hospital in Tianjin,China and analyzed for the patients recruited in the four clinical pathways for three main cardiovascular diseases,including coronary artery bypass grafting(CABG),single(SVR)and double(DVR)valve replacement as well as tetralogy of Fallot(TOF).The data for the same disease were analyzed annually and compared by ?2 test as well as one-way ANOVA for differences.Bonferroni was used for correction.(p<0.05 was considered having statistical significance.)Results:During the four years between 2013 to 2016,the admittance rates for the four CPs(including CABG,SVR,DVR,TOF),are comparatively stable(p>0.05)and all above 75% except for the rate in the year 2012 when Healthcare Information and Management Systems of the hospital was upgraded but the same time without the record of these patients by hand writing that affected the management of the CP.The admittance rates of CP for CABG and TOF reached almost 90% or even above.In 2016,the average length of stay reached the lowest point of the 5 years for patients in CPs of CABG(p<0.05),SVR,TOF or similar in the CP of DVR(the average length of stay was reduced but has no statistical difference).The cost in hospital of TOF is the most stable one compared with other CPs and reached the lowest point in 2016 when compared with the last 4 years(2013-2016).The cost of CABG reached the highest in 2015 but only has statistical significance when compared with year of 2013.In 2016,the cost of CABG was lower and controlled and has no statistically significance when compared with other years.The cost in hospital of the two CPs from valve repair were both comparatively stable during the years of 2012-2014(p>0.05)and reached the highest in 2016.The cost for SVR in pathways had significant increase when compared with the year of 2013(p<0.05).Further,the cost in 2016 for DVR was significantly higher than that in 2014(p<0.05).Conclusions:Our study for the first time vertically analyzed the five-year(2012-2016)average length of stay in hospital and average cost in hospital for the four CPs of three main cardiovascular diseases in a professional cardiovascular hospital built in 2003.According to the study,we found that continuous implementation of CP in cardiac surgery may further decrease the length of hospital stay and hospital cost or effectively control them in the hospital with comparatively high rate of CP admission.Effective CP management with continuous quality improvement is the key factor to improve the medical care as well as normalizing and standardizing medical behavior.Through the activities,such as training and information system construction etc.,of continuous quality improvement in the hospital,our study also provides a possible working experience for the large cardiovascular hospitals as well as the department of cardiac surgery in the state-owned general hospital to further improve the performance of CP management.