Klinischer Behandlungspfad für die Mammachirurgie: Pfadcontrolling und Effekte

Abstract

PURPOSE: The introduction of a DRG-based case fee system in Germany has required a rethinking of the design of patient treatments with the goal of providing high quality treatment while ensuring that the costs of treatment are covered. The aim of this study was to examine the effectiveness of implementing a clinical pathway in breast surgery. Parameters for this were the duration of in-hospital stay and cost trends. Additional objectives included an analysis of pathway monitoring and the further development of the clinical pathway. METHOD: After an analysis of the current situation and the target state, the Interdisciplinary Breast Center of Charite Berlin together with the Central Quality Management Department developed a clinical pathway, which included contributions by all specialists involved. After implementation of the clinical pathway, the impact for the years 2006 and 2007 was evaluated with regard to in-hospital stay, the number of cases, and the total cost per case, and pathway monitoring was carried out. RESULTS: After implementation of the clinical pathway, the mean in-hospital stay decreased by 17.7 % and the total cost of treatment per case sank by 23.4 % in 2007, compared to 2006 prior to implementation of the pathway. The introduction of the clinical pathway, to which all specialists involved had contributed, led to a significant reorganization of in-hospital operative care processes for the treatment of women with breast cancer. CONCLUSION: The introduction of clinical pathways can lead to a decrease in in-hospital stay and in the total cost per case through the standardization of processes and times. The implementation of a clinical pathway results in an optimization of the in-hospital course of treatment.