Critical Path Network-Bowel resection pathway saves $2,500 per case, cuts LOS
By Karen Johns, RN, MSN, CCRN, CNA
Director of Clinical Resource Management
Virginia Denomme, RN, RN-C
Project Manager
St. Joseph Mercy-Oakland
Pontiac, MI
St. Joseph Mercy-Oakland of Pontiac, MI, is a community-based nonprofit health care system that is part of newly formed Trinity Health. The 500-bed facility has an ambulatory surgery center and eight ambulatory care centers and has corporate affiliations with a hospice organization, a home health care company, and three long-term care facilities.
St. Joseph Mercy-Oakland has been working with pathways in different formats over the past 15 years. In the last two years, a successful format has been implemented. A generic format for a pathway was developed that is cost-effective, identifies best practice, assists in establishing a standard of care, coordinates care across the continuum, and streamlines documentation.
After this was completed, DRGs were targeted. They were selected based on high volume, high cost, or if there was a specific factor identified by the clinical care providers. One DRG selected was 148 (Bowel Resection with Ostomy). Virginia Denomme, a manager with an extensive surgical background, was selected as project manager after problems with patient education and length of stay were identified. Baseline quality indicators such as length of stay, cost, and patient satisfaction were monitored.
Other team members, including a pharmacist, a point-of-service care provider, a lab resource representative, and a physician were identified to help in the development process. Current actual practice was plotted out on the pathway format. Outcomes and interventions were developed, and opportunities for improved practice were identified and added to the format.
The finished pathway was presented to various approval bodies, including the Patient Care Council, Pharmacy and Therapeutics, the Surgical Committee, and the Clinical Practice Council. Once approved, education was conducted on the units involved and the pathway was implemented.
Within a three-month period, the baseline indicators were again monitored to measure success. As a result of the implementation of this pathway, we have seen an average $2,500 reduction in cost per case, a two-day decrease in length of stay as of January, and improved patient education.
This format has eliminated several other documentation tools such as the care plan, education plan, and education record. It is expected that in the near future, the pathway will lend itself to an electronic format.
Denomme continues to monitor the baseline data and produce a quarterly "report card" that tracks cost, length of stay, department costs, discharge disposition, and other benchmark data.
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