HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Turley, K. Articles by Tarnoff, H. Search for Related Content PubMed PubMed Citation Articles by Turley, K. Articles by Tarnoff, H.

The Annals of Thoracic Surgery, Vol 58, 57-63, Copyright © 1994 by The Society of Thoracic Surgeons

ARTICLES

Critical pathway methodology: effectiveness in congenital heart surgery

K Turley, M Tyndall, C Roge, M Cooper, K Turley, M Applebaum and H Tarnoff
California Pacific Medical Center, San Francisco 94115.

Critical pathway methodology has been demonstrated to provide producible reduction in average length of stay (ALOS) in adults in certain diagnostic-related groups and operations such as coronary artery bypass grafting. The efficacy of this approach in congenital heart surgery was explored. Two hundred eighty-six consecutive patients from a health maintenance organization treated by a single surgeon since the institution of diagnostic-related group coding at that health maintenance organization constituted the study group. One hundred fourteen patients were treated at a university hospital without critical pathway methodology (group 1) and 172, subsequently at the health maintenance organization institution using the methodology (group 2). Operation/lesion, age, and diagnostic-related group matching was possible in 61 pairs. Examination of the ALOS Hospital (operative and postoperative days) for the entire cohort revealed a 43.8% reduction in ALOS Hospital (p < 0.0001) and a 39.0% reduction in ALOS Intensive Care Unit (p < 0.0001). There was also significant reduction in ALOS Hospital and ALOS Intensive Care Unit in the operation/lesion- matched subsets. Outcome measures including operative and late mortality, readmission, unscheduled emergency room and clinic visits, and health maintenance organization family assessment survey demonstrated no improvement in outcome with increased hospital stay. Thus, critical pathway methodology when used in patients undergoing a congenital heart operation produces a significant reduction in hospital stay and intensive care unit stay as well as quality patient care with uniformity of outcome.

This article has been cited by other articles:

				N. Boluyt, C. R. Lincke, and M. Offringa Quality of Evidence-Based Pediatric Guidelines Pediatrics, May 1, 2005; 115(5): 1378 - 1391. [Abstract] [Full Text] [PDF]

				A. S. Mackie, K. Gauvreau, J. W. Newburger, J. E. Mayer, and L. C. Erickson Risk Factors for Readmission After Neonatal Cardiac Surgery Ann. Thorac. Surg., December 1, 2004; 78(6): 1972 - 1978. [Abstract] [Full Text] [PDF]

				E. S. Holmboe, T. P. Meehan, M. J. Radford, Y. Wang, and H. M. Krumholz What's Happening in Quality Improvement at the Local Hospital: A State Wide Study From the Cooperative Cardiovascular Project American Journal of Medical Quality, May 1, 2000; 15(3): 106 - 113. [Abstract] [PDF]

				L. A. Vricella, J. A. Dearani, S. R. Gundry, A. J. Razzouk, S. D. Brauer, and L. L. Bailey Ultra fast track in elective congenital cardiac surgery Ann. Thorac. Surg., March 1, 2000; 69(3): 865 - 871. [Abstract] [Full Text] [PDF]

				K. J. Zehr, P. B. Dawson, S. C. Yang, and R. F. Heitmiller Standardized clinical care pathways for major thoracic cases reduce hospital costs Ann. Thorac. Surg., September 1, 1998; 66(3): 914 - 919. [Abstract] [Full Text] [PDF]

				H. Campbell, R. Hotchkiss, N. Bradshaw, and M. Porteous Integrated care pathways BMJ, January 10, 1998; 316(7125): 133 - 137. [Full Text]

				R. M. Ungerleider, A. R. Bengur, A. L. Kessenich, R. J. Liekweg, E. M. Hart, B. A. Rice, C. E. Miller, N. W. Lockwood, S. A. Knauss, J. Jaggers, et al. Risk Factors for Higher Cost in Congenital Heart Operations Ann. Thorac. Surg., July 1, 1997; 64(1): 44 - 48. [Abstract] [Full Text]

				T. A. Merritt, D. Palmer, D. A. Bergman, and P. H. Shiono Clinical Practice Guidelines in Pediatric and Newborn Medicine: Implications for Their Use in Practice Pediatrics, January 1, 1997; 99(1): 100 - 114. [Abstract] [Full Text] [PDF]

				J. A. Hawkins, L. L. Minich, L. Y. Tani, J. E. Sturtevant, G. S. Orsmond, and E. C. McGough COST AND EFFICACY OF SURGICAL LIGATION VERSUS TRANSCATHETER COIL OCCLUSION OF PATENT DUCTUS ARTERIOSUS J. Thorac. Cardiovasc. Surg., December 1, 1996; 112(6): 1634 - 1639. [Abstract] [Full Text]

				K. Turley, M. Tyndall, K. Turley, D. Woo, and T. Mohr Radical Outcome Method : A New Approach to Critical Pathways in Congenital Heart Disease Circulation, November 1, 1995; 92(9): 245 - 249. [Abstract] [Full Text]

				J. T. Davis, H. D. Allen, K. Felver, H. M. Rummell, J. D. Powers, and D. M. Cohen Clinical Pathways Can Be Based on Acuity, Not Diagnosis Ann. Thorac. Surg., May 1, 1995; 59(5): 1074 - 1078. [Abstract] [Full Text]

				W. M. Novick, D. C. Watson Jr, B. S. Alpert, J. A. Becker, T. G. DiSessa, J. C. Ring, S. E. Birnbaum, and N. A. Chase Patent Ductus Arteriosus Ligation: Are We Doing Better? Ann. Thorac. Surg., April 1, 1995; 59(4): 822 - 824. [Abstract] [Full Text]