Abstract
Background.
This is a retrospective review of medical and financial records, conducted to test the hypothesis that the use of clinical pathways specifically designed for the management of the operation for thyroid and parotid tumors will result in the improved outcomes of patients.
Methods.
Twenty-six patients before implementation of a clinical pathway for thyroid tumor were compared with forty-six patients after implementation of the pathway. Also, twenty-five patients before implementation of a clinical pathway for parotid tumor were compared with twenty-nine patients after implementation of the pathway. Analyses of clinical outcome, length of hospitalization, and cost were performed. An unpaired t-test was used for statistical analysis.
Results.
‹Thyroid tumor clinical pathway›
For pathway patients, the average number of days using a drain tube was decreased to 2.8±1.1 days, versus 3.5±1.2 days for prepathway patients (p=0.03). The average length of hospitalization was decreased to 10.8±3.5 days, versus 15.2±4.7 days (p<0.0001). The average length of postoperative hospitalization was decreased to 6.5±2.3 days, versus 8.5±3.0 days (p=0.004). The average cost was decreased to 56, 994±15, 296 points (1 point=10 yen), versus 65, 619±18, 083 points (p=0.03).
‹Parotid tumor clinical pathway›
For pathway patients, the average length of hospitalization was decreased to 12.0±1.0 days, versus 22.0±3.2 days for prepathway patients (p=0.002). The average length of post-operative hospitalization was decreased to 6.9±0.8 days, versus 13.1±2.5 days (p=0.01). The average cost was decreased to 60, 424±3, 217 points (1 point=10 yen), versus 86, 286±12, 801 points (p=0.04).
Conclusions.
In using clinical pathways for thyroid and parotid tumors, we have maintained the quality of the operation and patient care, and have decreased the length and cost of hospitalization. With this study, we have concluded that implementing clinical pathways for thyroid and parotid tumors is beneficial for all parties.
