PubMed · 16318062
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Nick Lipley. 2005. Foreign exchange.. https://pubmed.ncbi.nlm.nih.gov/16318062/
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BACKGROUND AND OBJECTIVE: In analogy to industrial process management, clinical pathways have been introduced for operational process organisation in orthopedic and interventional procedures as well as for conservative treatments. Within this study, introduction and continuous, systematic application of clinical pathways at a surgical department of a university hospital was investigated. METHODS: Analysis was performed by IT-based (SAP/i. s. h.med) evaluation of the registered data regarding pathway violations. Additionally, patients' records were matched with the computerized data for quality assurance of pathway documentation. RESULTS: 501 patients were entered in 16 clinical pathways (31 +/- 39 patients per pathway). The mean period from the introduction of a distinct pathway to the data acquisition of the present study ranged from 2 to 14 months (mean 7+/-7.5 months). Pathway violations correlated with the complexity, but not with the period since the pathway was introduced. Organisational reasons next to medical reasons (i. e. delayed gastric function or wound healing) were the most frequent causes for pathway violations. CONCLUSION: Clinical pathways may not only be realised for operative procedures or conservative treatments, but represent a clinical and administrative management instrument at a surgical department of a university hospital for daily work routine. They are suitable as an instrument for clinical quality and risk management, as an economic control instrument in reorganisation phases as well as in the routine of surgical clinics.
The present study was performed to explore a new approach to systematization of the management of paper-based clinical pathways by developing a new system requiring little capital investment. A new system was developed and incorporated into an existing network at a hospital with a paper-based clinical pathway management system. The effectiveness of this new system was examined by comparing the management efficiency of clinical pathways before and after its introduction, and by comparison of the new system with other such systems currently in place at other medical institutions with regard to efficiency. In addition, the acceptability of the system for other medical institutions was examined by providing free access to the software on the Internet. The development costs of the new system were low. Although the new system has been in place for more than 3 years, no problems have yet been encountered in either the existing network system or in the management system itself. The new system allows the processing of statistics and analysis of circulation or variance automatically, neither of which were possible in the original paper-based system. We provided open access to the system as free software on the Internet, and it has since been downloaded by many medical institutions and enterprises in Japan. This system is very useful for institutions where it is difficult to introduce expensive new systems for systematic management of clinical pathways, such as electronic medical records, because of problems regarding capital or system management, and it may also be useful in other countries.
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