Clinical Pathway Implementation Improves Efficiency of Care in a Maxillofacial Head and Neck Surgery Unit

Abstract

Purpose: Clinical pathways have become an important and simple method of improving patient outcomes and decreasing health care resource usage. The purpose of this study was to evaluate early outcomes associated with the implementation of a clinical pathway in a maxillofacial head and neck surgery unit.

Materials and methods: This investigation is a retrospective cohort study of patients who underwent microvascular reconstruction of the head and neck from January 1, 2014 through December 31, 2014. Continuous variables were compared among 4 groups using analysis of variance or Kruskal-Wallis test, and categorical variables were compared using χ² test or Fisher exact test where appropriate. The primary predictor variable was use of the clinical pathway. Groups included patients treated by surgeon A during periods before and after implementation of a postoperative clinical pathway. Two groups treated by surgeon B also were evaluated during the same periods and served as external controls. Each period covered a span of 6 months. Outcome variables across groups were evaluated, including length-of-stay metrics, infection rates, transfers to the intensive care unit, and unplanned return to the operating room.

Results: Sixty-six patients who underwent microvascular head and neck reconstruction were included. There was a significant decrease in the average length of stay (P = .0364) and an increase in the rate of discharge within 7 days (P = .0416) in the group treated with the clinical pathway. Other outcomes, including infection rate, transfer to the intensive care unit, and unanticipated return to the operating room, showed no relevant difference among groups.

Conclusions: The results of this study suggest that implementation of a clinical pathway can be beneficial for efficient management of postoperative care in the setting of microvascular head and neck reconstruction. More predictable and shorter lengths of stay are achievable and the clinical pathway serves as a valuable means of improving communication of the clinical care team.