Clinical pathways have been implemented nationwide but little is understood about their effects on efficiency of care and patient outcomes. The present study examined the effects of both development and implementation of two renal transplant pathways.
Cohorts of patients at a university hospital were compared before, during, and after the development and implementation of two renal transplant clinical pathways: isolated renal transplant from cadaveric donors (n = 170) or from living donors (n = 178). Clinical pathways for cadaveric and living related donor renal transplants were developed and implemented. Hospital length of stay and complications and infections after renal transplant were determined.
Mean length of hospital stay decreased after development and implementation of the cadaveric donor pathway (11.8 days after implementation versus 17.5 days before development). Cadaveric kidney recipients also had statistically fewer complications and infections after both guideline development and guideline implementation (57.1% before, 24.5% during, 18.5% after), but the greatest effect occurred during development. All of these findings persisted after control for demographic and comorbid factors. There were no changes in hospital stay, complications, or infections in the patients who received kidneys from living donors.
The development and use of a clinical pathway for cadaveric donor renal transplant patients was associated with a significant decline in length of stay, complications, and infections, but much of the effect was seen during development rather than during implementation, and a closely related pathway for living related donor patients had no effect. Further understanding of what factors predict an effective pathway and what elements (ie, development or implementation) have an effect should be undertaken.
*From the Department of Medicine at Hennepin County Medical Center and the University of Minnesota, Minneapolis.
†From the Clinical Outcomes Research Center, University of Minnesota Institute of Health Services Research and Policy, Minneapolis.
‡From the University of Minnesota Hospital, Minneapolis.
Supported, in part, by the Clinical Outcomes Research Center of the Institute of Health Services Research and Policy, University of Minnesota and the University of Minnesota Hospital and Clinic.
Address correspondence to: Jeremy Holtzman, MD, MS, Institute of Health Services Research, School of Public Health, Box 197 Mayo, 420 Delaware Street SE, Minneapolis, MN 55455.
Received June 17, 1997; initial review completed July 29, 1997; final acceptance November 20, 1997.