Paper
Saturday, July 24, 2004
This presentation is part of : Nursing Care Challenges
Integrated Clinical Pathway of Transurethral Resection of the Prostate: Impact on Clinical Quality, Cost, and Patient and Staff Satisfaction
Khurshid Khowaja, PHD, Nursing Services, Nursing Services, The Aga Khan University Hospital, Karachi, Sindh, Pakistan
Learning Objective #1: Measure outcomes and variances of clinical pathways on the clinical quality (CQ) of care for patients attending AKUH for TURP
Learning Objective #2: Measure length of stay as per plan, variances in financial charges to patients undergoing TURP, and the overall cost of their hospitalization
The central focus of this study is an investigation into how the implementation of a clinical pathway for the surgical procedure of transurethral resection of the prostate (TURP) impacted on clinical quality, cost, and patient and staff satisfaction at the Aga Khan University Hospital (AKUH) in Pakistan. Clinical pathways are designed to streamline patient care delivery, maximize efficiency, minimize cost, and improve the care outcome. They address variability in practice by having providers agree prospectively on a common regimen of clinical intervention.

This study utilized a quasi-experimental, non-equivalent control group study design to answer the research questions. The study population consisted of a convenience sample of patients undergoing surgery for TURP (control and experimental), recruited to measure satisfaction among patients, and of health team members, recruited to measure satisfaction among nurses, physicians and others involved in the delivery of care to the patients with a TURP surgical intervention.

The findings showed a significant difference in the variances and outcomes as a result of the TURP clinical pathway intervention. The results showed that TURP clinical pathway intervention significantly improved all twelve nursing- and physician-related variances and outcomes, such as complete documentation, delayed consultation, delayed education and other variances. Clinical pathway intervention also significantly reduced hospital-related variances, and post-operative problems such as electrolyte imbalance, phlebitis, constipation, and urinary tract infection (UTI). The findings also showed significant improvement in patient and staff satisfaction due to clinical pathway utilization. However, no significant difference was observed in patient, hospital or financial related variances.

The keys to a successful clinical pathway program lie in continued support and acceptance from clinicians, support and leadership from senior management, and the presence of a dedicated team of case managers, doctors and paramedical professionals.

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