Impact of Clinical Pathway Implementation of Laparoscopic Appendectomy on Length of Stay, Hospital Cost and Patient Health Outcome at Emc Pekayon Hospital (original) (raw)
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The Implementation of Acute Appendicitis Clinical Pathway Toward Average Length of Stay
LIFE: International Journal of Health and Life-Sciences
Acute appendicitis is a gastrointestinal disease that the incidence of it was increased in Indonesia from 566132 people in 2009 became 621435 in 2010. Cases of acute appendicitis were continued to increase every year at Condong Catur Hospital. A clinical pathway ideally suited to the management of common surgical conditions with well-defined outcomes, such as appendicitis. Implementation of the clinical pathway as a clinical guidance needed to be measured to find out the impact on the outcome of the patient. This study aims to find out a significant impact of acute appendicitis clinical pathway toward the average length of stay. This study used a cross-sectional design, carried out at Condong Catur Hospital. Data were collected from the medical records of patients, both before (52 medical records) and after (50 medical records) the clinical pathway was implemented. Frequency distribution result was performed using a descriptive statistics. The chi-square test was performed to find out the significant difference between variables. This study noted the majority of acute
Appendicitis Clinical Pathway Implementations Compliance Evaluation in Hospital
2017
Background : Clinical pathway (CP) is a collaborative guidance for patients treatments that focused on diagnosis, clinical problems, and stages of care. CP implementation becomes a guideline on hospital quality and safety improvement for the patient services. Method : The research used a descriptive-qualitative mixed methods. Primary data collected through medical record and secondary data is done by interview and observation by using CP format. Results : From medical records total, 23 cases were found that met the inclusion criteria. The acute appendicitis case in adults is more than children in number (3,6:1). Acute appendicitis CP compliance is 86%. There are three problems in CP compliance of acute appendicitis i.e doctor's visit adherence (physician in charge of patient 87%, 0% anesthesia), 65% adherence therapy compliance, and 52% inpatient admission. The root of the problem is the lack of socialization, monitoring, and evaluation of established standards. Some activity va...
Background Although many studies have compared outcomes of laparoscopic appendectomy (LA) and open appendectomy (OA), some clinical and economic outcomes continue to be controversial, particularly in lowmedium-income countries. We aimed at determining clinical and economic outcomes associated with LA versus OA in adult patients in Colombia. Methods Retrospective, cohort study based on administrative healthcare records included all patients who underwent LA or OA in Colombia's contributory regime between July 1, 2013, and September 30, 2015. Outcomes were 30-day mortality rates, ICU admissions rates, length of stay (LOS), and hospital costs provided until discharge. Propensity score matching techniques were used to balance the baseline characteristics of patients (age, sex, comorbidities based on the Charlson index, insurer, and geographic location) and to estimate the average treatment effect (ATE) of LA as compared to OA over outcomes. Results A total of 65,625 subjects were included, 92.9% underwent OA and 7.1% LA. For the entire population, 30-day mortality was 0.74 per 100 appendectomies (95% CI 0.67-0.81), the mean and median LOS were 3.83 days and 1 day, respectively, and the ICU admissions rate during the first 30 days was 7.92% (95% CI 7.71-8.12). The ATE shows an absolute difference in the mortality rate after 30 days of -0.35 per 100 appendectomies (p = 0.023), in favor of LA. No effects on ICU admissions or LOS were identified. LA was found to increase costs by 514.13 USD on average, with total costs of 772.78 USD for OA and 1286.91 USD for LA (p \ 0.001). Conclusions In Colombia's contributory regime, LA is associated with lower 30-day mortality rate and higher hospital costs as compared to OA. No differences are found in ICU admissions or LOS.
Background: Identification of variation in practice is a key step towards standardization of service and determination of reliable quality markers. This study aimed to investigate variation in provision and outcome of emergency appendicectomy. Methods: A multicentre, trainee-led, protocol-driven, prospective observational cohort study was performed duringMay and June 2012. The main outcome of interest was the normal histopathology rate; secondary outcomes were laparoscopy and 30-day adverse event rates. Analysis included funnel plots and binary logistic regression models to identify patient- and hospital-related predictors of outcome. Results: A total of 3326 patients from 95 centres were included. An initial laparoscopic approach was performed in 66·3 per cent of patients (range in centres performing more than 25 appendicectomies over the study period: 8·7–100 per cent). A histologically normal appendix was removed in 20·6 per cent of patients (range in centres performing more than 25 procedures: 3·3–36·8 per cent). Funnel plot analysis revealed that 22 centres fell below three standard deviations of the mean for laparoscopy rates. Higher centre volume, consultant presence in theatre and daytime surgery were independently associated with an increased use of laparoscopy, which in turn was associated with a reduction in 30-day morbidity (adjusted for disease severity). Daytime surgery further reduced normal appendicectomy rates. Increasing volume came at the cost of higher negative rates, and low negative rates came at the cost of higher perforation rates. Conclusion: This study reveals the extremely wide variation in practice patterns and outcomes among hospitals. Organizational factors leading to this variation have been identified and should be addressed to improve performance.
Surgery, 1997
Clinical pathways @t-e increasingly being used by hospitals to improve efficiency in the care oj'certain patient populations; howevet; little prospective data are available to support their use. This study examined whether using a clinical pathway for patients undagoing ileal pouch/anal anastomosis, a complex procedure in which we had extensive practical experience, affected hospital chal-ges 01 length of stay (LOS). Methods. A clinical pathway was developed to serve patients undergoing elective total colectonq and ileal pouc?L/anal anastomosis. All operations were performed b;y two attending physicians (J.E.I?, M..LV.). Before im@ementation, 10 pilot patients woe ro.sfiectivebmonitoredtoensurethathospitalchargeswereaccuratelygenerated.Inadditzon,chargeauditswereperformedbyanoutsideagencytouerfitheaccuracyofthehospitalbills.Thepathwaywasthenimplamented,and14patientswereprospectivelyanalyzed.Results.Inallpatientstheprincipaldicrgnosiswasulcerativecolitis,wzththeexceptionofthreepatientswithfamilialpol;)llosis.Meanexternalauditchargeswerewithin276ofthehospitalbills;tfzereforethehospitalbillswe−reusedinallcalculations.ThemeanLOSdecreasedfrom10.3davsto7.5days(p=0.046)for−patientsonthepathwayversuspilotpatients.Meanhospitalchargesalsodecreasedszgnificantly,jkomro.sfiectiveb monitored to ensure that hospital charges were accurately generated. In additzon, charge audits were performed by an outside agency to uerfi the accuracy of the hospital bills. The pathway was then implamented, and 14 patients were prospectively analyzed. Results. In all patients the principal dicrgnosis was ulcerative colitis, wzth the exception of three patients with familial pol;)llosis. Mean external audit charges were within 2 76 of the hospital bills; tfzerefore the hospital bills we-re used in all calculations. The mean LOS decreased from 10.3 davs to 7.5 days (p = 0.046) for-patients on the pathway versus pilot patients. Mean hospital charges also decreased szgnifican tly, jkom ro.sfiectivebmonitoredtoensurethathospitalchargeswereaccuratelygenerated.Inadditzon,chargeauditswereperformedbyanoutsideagencytouerfitheaccuracyofthehospitalbills.Thepathwaywasthenimplamented,and14patientswereprospectivelyanalyzed.Results.Inallpatientstheprincipaldicrgnosiswasulcerativecolitis,wzththeexceptionofthreepatientswithfamilialpol;)llosis.Meanexternalauditchargeswerewithin276ofthehospitalbills;tfzereforethehospitalbillswe−reusedinallcalculations.ThemeanLOSdecreasedfrom10.3davsto7.5days(p=0.046)for−patientsonthepathwayversuspilotpatients.Meanhospitalchargesalsodecreasedszgnificantly,jkom21,650 to $17,958 per patien t (p = 0.005).
Acute appendicitis is one of the most common surgical emergencies and appendectomy is the most common general surgical operation performed in the world. Despite the improvement of laparoscopic approach through the years and numerous studies comparing open and laparoscopic approach, it is still not proven as to which procedure is superior in the management of acute appendicitis. Our study was a prospective comparative study between laparoscopic and open appendectomy in terms of duration of surgery, intraoperative and postoperative complications, postoperative pain, days to resume oral diet and duration of hospital stay. In our study 200 patients who came with features of acute appendicitis to AJ Institute of Medical Science Hospital from August 2016 to September 2018 were divided into two groups, 100 patients who underwent open appendectomy and 100 patients who underwent laparoscopic appendectomy. After collection of data related to patient demography, preoperative evaluation, intraoperative and postoperative parameters, analysis was done and the two groups were compared. Laparoscopic approach was associated with a significantly less amount of post-operative pain (p<0.001), an early resumption oral diet (p<0.05), a shorter hospital stay (p<0.001) and a significantly less wound infection rate (p < 0.05). Laparoscopic appendectomy has significant less postoperative pain, early recovery, comparatively less complications, shorter hospital stay and earlier return to normal activities as compare to open appendectomy. It is of our view that Laparoscopic Appendectomy be contemplated in all cases of acute appendicitis.
Indian Journal of Public Health Research & Development, 2018
Introduction: The National Health Insurance (JKN) has been implemented in Indonesia since 2014 and the dreams for Universal Health Coverage (UHC) by the year 2019. It encourages the need for systems that can reduce losses for patients and hospitals through INA-CBGs. Currently, the participant number and health facilities that cooperate with Social Health Insurance (BPJS) increased significantly, while facts shown the lack of funds for the implementation of JKN during 2014-2015. These situations forced the hospitals to take effective action as quality-cost control by using clinical pathway as a guide of medical treatment for patient. Therefore, this study will analyze comprehensively, about the availability, loyalty, conformity, and cost effectiveness after the implementation of clinical pathway. Method; This study used mix-method approach with sequential explanatory design. Data was collected through observations, in-depth interviews, document reviews, and also Focus Group Discussion (FGD). Respondents were selected purposively, consist of medical and managerial staff, and insured patients. This study was a pilot project which was conducted in Bantaeng district Hospital, one of public hospital in south Sulawesi Results; The early study shown that, Bantaeng District Hospital did not implement the qualitycost control system due to the unavailability of clinical pathway guidance. Therefore, this study encouraged medical and managerial staff to establish clinical pathway guidance and evaluating the implementation (The study is still going on and predicted until July 2017). Conclusions; Quality-cost control system through clinical pathway implementation can reduce the Medical Errors, Length of Stay, Unnecessary Expenditure, also increasing Satisfaction and Quality of service. Therefore, the hospital need to provide clinical guidance through clinical pathway document to ensure patients to get the required services according to their condition and the cost accordance to the treatment received by the patients.
GHMJ (Global Health Management Journal)
Background: Financial costs are recognized as one of the causes of lack access to adequate health services, not least in the treatment of Acute Appendicitis with BPJS Healthcare in Budi Kemuliaan Hospital, Batam. Data describing health workers' awareness of costs is still limited. Increasing awareness of health workers can encourage to increase treatment efficacy and reduce wasteful spending costs. Aims: This study objective was to analyze the cost awareness of health workers' in the efficiency of Acute Appendicitis treatment. Methods: This research was a qualitative descriptive study accompanied by direct observation on the implementation of clinical pathways and SOP in cases of Acute Appendicitis in Budi Kemuliaan Hospital, Batam. In this study also conducted interviews involving nine main informants and three triangulation informants. Result: There was a low awareness of costs identified in the implementation of clinical pathways and SOP in cases of Acute Appendicitis in ...
Laparoscopic Versus Standard Appendectomy Outcomes and Cost Comparisons in the Private Sector
Journal of Gastrointestinal Surgery, 2005
Minimally invasive surgery has been proposed as the preferred treatment strategy for various gastrointestinal disorders due to shorter hospital stay, less pain, quicker return to normal activities, and improved cosmesis. However, these advantages may not be straightforward for laparoscopic appendectomy, and optimal management of remains controversial. One hundred forty-eight patients with clinical and radiologic diagnoses of acute appendicitis treated in two different hospitals were retrospectively reviewed. Seventy-eight patients underwent laparoscopic appendectomy in hospital A and 70 patients underwent standard appendectomy in hospital B. Patients treated by either type of surgery were compared in terms of clinical and pathologic features, operation characteristics, complications, and costs. There were no significant differences between both groups in terms of clinical features, radiologic studies, complications, and final pathology findings (P O .05). Hospital stay was significantly shorter and bowel movements recovered quicker in the laparoscopy group. However, overall and operating room costs were significantly higher in patients treated by laparoscopy (P ! .01). Our series show a subtle difference in terms of hospital stay and bowel movement recovery, favoring patients treated by laparoscopy. However, these results have to be carefully examined and weighed, because overall costs and operating room costs were significantly higher in the laparoscopy group. ( J GASTROINTEST SURG 2005;9:1174-1181) Ó
PLoS ONE, 2013
Background: Mounting evidence supports the use of laparoscopic techniques for the treatment of simple appendicitis. However, most of the advantages of these techniques are of limited clinical relevance. This study compares the treatment outcomes of laparoscopic appendectomies and open appendectomies performed in Taiwan. Methods: This study uses data from the 2007 to 2009 Taiwan National Health Insurance Research Database. The study sample included 65,339 patients, hospitalized with a discharge diagnosis of acute appendicitis (33.8% underwent laparoscopic appendectomy). A generalized estimated equation (GEE) was performed to explore the relationship between the use of laparoscopy and 30-day re-admission. Hierarchical linear regressions were performed to examine the relationship between the use of laparoscopy, the length of stay (LOS), and the cost per discharge. Results: A significantly lower proportion of patients undergoing laparoscopic appendectomies were re-admitted within 30 days of their index appendectomy, in comparison to patients undergoing open appendectomies (0.66% versus 1.925, p,0.001). Compared with patients undergoing open appendectomies, patients undergoing laparoscopic appendectomies had a shorter LOS (4.01 versus 5.33 days, p,0.001) and a higher cost per discharge (NT$40,554 versus NT$38,509, p,0.001. In 2007, the average exchange rate was US$1 = NT$31.0). GEE revealed that the odds ratio of 30-day readmission for patients undergoing laparoscopic appendectomy was 0.38 (95% CI = 0.33-0.46) that of patients undergoing open appendectomies, after adjusting for surgeon, hospital, and patient characteristics, as well as for the clustering effect of particular surgeons and the propensity score. Conclusion: This study found that laparoscopic appendectomies had a lower 30-day re-admission rate, and a shorter LOS, but a slightly higher cost per discharge than open appendectomies.