Compliance of Clinical Pathways in Elective Laparoscopic Cholecystectomy: Evaluation of Different Implementation Methods
Compliance of Clinical Pathways in Elective Laparoscopic Cholecystectomy: Evaluation of Different Implementation Methods
Compliance to the clinical pathway, postoperative complication and total cost of the
 hospitalisation of patients undergoing elective cholecystectomy for symptomatic
 cholecystolithiasis were collected over two different periods: using a clinical pathway in
 form of a paper based check-list (group 1, n=118) or a clinical pathway integrated into the
 paper based medical treatment and nursing documentation (group 2, n=123). Outcome measures
 were compliance of the clinical pathway and total costs per case.
Data of patients undergoing elective cholecystectomy for symptomatic cholecystolithiasis were
 collected over two different periods: a clinical pathway in form of a paper based check-list
 (check-list group, n=118, or in form of a clinical pathway integrated into the paper based
 medical treatment and nursing documentation (integrated clinical pathway group, n=123. A
 standardized clinical pathway for elective laparoscopic cholecystectomy in form of a check
 list was initially established in 2008 and evaluated during a 6-month period (August 2011
 until January 2012) at the University of Tuebingen. The integrated clinical pathway was
 evaluated during a 6-month period after an introduction phase of 2 months (November 2012
 until April 2013). The contents of both clinical pathways were identical, especially
 concerning the standardization of perioperative fluid management, perioperative monitoring,
 nutrition, analgesia, reserve medications, preoperative and postoperative examinations,
 detailed laboratory blood testing, nursing standards and planned discharge.

 Primary outcome measure was the compliance to the clinical pathway defined as an adherence of
 more than 80% to the presetted pathway items.
Inclusion Criteria:

 -  patients undergoing elective laparoscopic cholecystectomy

 Exclusion Criteria:

 -  emergency procedures

 -  conversion to open cholecystectomy