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The impact of a post-operative clinical care pathway on head and neck microvascular free tissue transfer outcomes

Published online by Cambridge University Press:  23 January 2020

R Mhawej ,
B M Harmych ,
J J Houlton ,
M E Tabangin ,
J Meinzen-Derr  and
Y J Patil
R Mhawej
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati Medical Center, Ohio, USA
B M Harmych
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati Medical Center, Ohio, USA
J J Houlton
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati Medical Center, Ohio, USA
M E Tabangin
Affiliation:
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Ohio, USA
J Meinzen-Derr
Affiliation:
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Ohio, USA
Y J Patil*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati Medical Center, Ohio, USA
*
Author for correspondence: Dr Yash J Patil, 231 Albert B Sabin Way, Cincinnati, OH45267-0528, USA E-mail: [email protected] Fax: +1 513 558 5203
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Abstract

Objective

To study the impact of a clinical care pathway and computerised order set on short-term post-operative outcomes for patients undergoing head and neck free tissue transfer.

Methods

In this retrospective cohort study, patients who underwent head and neck free tissue transfer by a single reconstructive surgeon between January 2007 and July 2009 were assigned to one of two cohorts based on the timing of their surgery: pre- or post-clinical care pathway implementation. Measured outcomes included peri-operative complications and mortality, length of hospital stay and costs, unplanned reoperations, and readmissions within 30 days of discharge.

Results

The pre-clinical care pathway cohort included 81 patients and the post-clinical care pathway cohort comprised 46. Implementation of the clinical care pathway was associated with decreased variability in length of hospital stay (median (interquartile range) = 8 (6, 11) vs 7 (6, 9) days). The post-clinical care pathway cohort also had a significantly lower unplanned reoperation rate (15.2 vs 35.8 per cent, p = 0.01).

Conclusion

A clinical care pathway is a successful means of standardising and improving complex patient care. In this study, care pathway implementation in head and neck free tissue transfer patients improved efficiency and the quality of patient care.

Keywords

Critical PathwaysHead And Neck NeoplasmsFree Tissue FlapsLength Of StayPatient Readmission
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 2 , February 2020 , pp. 150 - 158
Copyright
Copyright © JLO (1984) Limited, 2020

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Footnotes

Dr Y J Patil takes responsibility for the integrity of the content of the paper

Presented in part as a poster at the American Academy of Otolaryngology – Head and Neck Surgery Foundation Annual Meeting and OTO Expo, 13 November 2010, Boston, Massachusetts, USA.

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