Utilization of clinical pathway on open appendectomy: A quality improvement initiative in a private hospital in the Philippines
Abstract
Objective: This study was done to evaluate the utilization of Clinical Pathway (CP) on open appendectomy as a quality improvement (QI) initiative.
Methods: The CP document was developed from the clinical practice guideline created by the Philippine College of Surgeons using an event-timeline tabular checklist format. After a hospital-wide education, the CP was implemented on January 1, 2010 as the QI intervention. Appendectomies done four years prior to the intervention were assigned to the pre-pathway group while those done five years after were assigned to the post-pathway group. Demographic data were collected including the different clinical outcomes such as the average length of stay, co-morbidity, diagnostic modality used, hospital cost, and variance rate. Data were presented as mean ± SD and percentage which ever were applicable. Statistical analysis was done using Student t-Test for numerical data and chi-square for dichotomous data. Significance was set at p<0.05.
Results: Two hundred ninety five patients were included in the study. Separate analysis was done for uncomplicated (Pre-pathway Group, n=49 and Post-pathway group, n=139) and complicated (Pre-pathway Group, n=38 and Post-pathway Group, n=69) open appendectomies. Results showed that diagnosis was achieved through history and physical examination. Ultrasound use did not significantly differ between groups and types of open appendectomy. Major findings showed significant decrease in ALOS, hospitalization cost, and variance in the post-pathway group compared with the pre-pathway group (p<0.05).
Conclusion: These findings supported the use of CP in QI of healthcare in commonly done surgeries like appendectomy.
Keywords:
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).