The application of “Clinical pathway” in the treatment of lumbar discectomy patients

Abstract

Background: Many benefits have been associated with the use of clinical pathways. The idea of Clinical pathways has been used to reduce length of hospital stay, readmissions, and resource utilization and also to increase patient satisfaction. It facilitates the management of defined patient groups using interdisciplinary plans of care. The aim of this study is to evaluate the effectiveness of clinical pathways in patients with lumbar disc herniation who have undergone discectomy. Materials and Methods: We introduced a clinical path for discectomy of lumbar disc herniation from March 1999 through June 2001. One hundred and fifty eight patients who were managed on a clinical pathway for a 27-month study period were compared with a retrospective group of 64 patients who underwent the same procedure prior to the pathway’s implementation. The variables of the study are length of postoperative hospital stay, variance rates, and patient’s satisfaction. Results: Variance of discharge was recorded in eleven of these patients (6.2%). The main reasons of the variance were postoperative problems (i.e. delay of recovery, and recurrence of disc herniation). The average length of stay was reduced from 17.5 days prior to implementation of pathways to 14.8 days in clinical pathway group. Almost all patients were satisfied using clinical pathways. Conclusion: We concluded that a clinical pathway adapted for discectomy of lumbar disc herniation, provided significant improvement in outcome, satisfaction and recovery rates. Factors critical to success are multidisciplinary teamwork and communication. Clinical pathways can be used as a means of incorporating evidence-based medicine into clinical practice. Variance analysis of the pathways can be utilized as a process of quality control to improve patient outcomes.