Prior to the development of clinical pathways supported by clinical data, our hospital attempted to alleviate patient costs and shorten hospital days in full compliance with the fixed clinical pathway. Unfortunately, this attempt didn’t make a satisfactory achievement. The utilization rate of clinical pathway is low, and the mutation rate is high. This might be caused by the fact that our previous fixed clinical pathway templates limit our physicians’ role in clinical decision-making. Therefore, based on evidence-based medicine, we used historical data to help clinicians build clinical pathway templates adapted to the actual situation of local hospitals, and developed a clinical pathway management system.
The LOS is an indicator of efficiency in the treatment of ischemic brain infarctions. The clinical pathways application significantly shortened the LOS by 1.4 days (8.4%) per cerebral infarction patient compared with control group. The main factors contributing to the amelioration of LOS varied and the biggest proportion of variance was explained by socio-demographic and clinical factors measured on patient level. Hospital equipment contributed somewhat additionally to the explanation of variance for hospitals specializing in internal and geriatric medicine. The clinical pathway standardizes the behavior of diagnosis and treatment, reduces unnecessary examination and inspection items and improves the efficiency of treatment, thus shortening the patient’s time in hospital. The inspection costs reduction observed in the study might also benefit from the application of clinical pathway.
A previous study demonstrated the LOS, rescue, payment methods, gender, treatment outcomes and admissions were the main factors affecting hospital costs. In this study, the average hospital costs decreased $43.91 compared to without a clinical pathway, but there was no statistically significant (P = 0.15, Table 2). Although, it was found that hospital stay was a major factor of hospital cost, and comprehensive measures should be taken to shorten the hospital costs. Our findings do not yet well explain this view. This also illustrates the complexity of clinical processes and the difficulty of making clinical pathways.
Nowadays, there is no consistent and standardized nursing process to measure deviations in process or cost before we implement the clinical pathway for cerebral infarction treatment. Our new clinical pathways facilitate multidisciplinary communication, data collection, data analysis and feedback to suppliers. Clinical pathways are difficult to be designed and implemented because it is a highly interdisciplinary expertise involving knowledge and staff from various departments, thus resulting ini poor coordination and inefficient treatments.. Therefore, scientific data support and optimized treatment strategies are critical for measuring and reengineering clinical pathways.
Discharge against medical advice from the hospital is an unneglectable issue from point of view of treatment management, health costs as well as the side effects of treatment . As our results indicated, the rate of discharge against medical advice in our study was decreased dramatically from 7.9% to 4.4%. Unfortunately, we were unable to get data on the patient or family satisfaction survey. However, the decline in the rate for discharge against medical advice might indirectly indicate that the patient’s satisfaction has improved.
Although clinical pathways made a progressive achievement in our hospital, there are still some physicians who question the effects of clinical pathways and even worry about the excessive emphasis on variability will threaten their autonomy and limit their ability to cope with specific patients. However, after the implementation of our new clinical pathways, physicians are increasingly hugging clinical pathways because our new clinical pathways provide the best treatment options and optimize the process of diagnosis and treatment. Besides, physicians’ decisions were incorporated into our new clinical pathways. Under some unexpected circumstances, physicians even have the discretion to go beyond the pathways and behave as they did without pathways.
Together, our clinical pathways might benefit more physicians and patients if there are more hospitals can employ this system. Considering the fact that medical resources vary significantly from metropolitan cities to rural counties in China, the more advanced clinical pathways should be established according to local medical resource status.