Abstract
BackgroundCare pathways (CPs) are helpful in reducing unwanted variation in clinical care. Most studies of CPs show they improve clinical outcomes but there is little known about the long-term impact of CPs as part of a sustained quality management program. Head and neck (HN) surgery with free flap reconstruction is complex, time-consuming and expensive. Complications are common and therefore CPs applied to this patient population are the focus of this paper. In this paper we report outcomes from a 9 year experience designing and using CPs in the management of patients undergoing major head and neck resection with free flap reconstruction.MethodsThe Calgary quality management program and CP design is described the accompanying article. Data from CP managed patients undergoing major HN surgery were prospectively collected and compared to a baseline cohort of patients managed with standard care. Data were retrospectively analyzed and intergroup comparisons were made.ResultsMobilization, decannulation time and hospital length of stay were significantly improved in pathway-managed patients (p = 0.001). Trend analysis showed sustained improvement in key performance indicators including complications. Return to the OR, primarily to assess a compromised flap, is increasing.ConclusionsCare pathways when deployed as part of an ongoing quality management program are associated with improved clinical outcomes in this complex group of patients.
Highlights
Introduction and backgroundIn the article that accompanies this paper we outline the importance of head and neck cancer and the critical role that surgery plays in its management
Seminal work starting in the 1990s showed the impact of clinical care pathways in improving the quality and cost of care in a broad range of conditions including head and neck cancer surgery
Patients undergoing major resection with free flap reconstruction are managed overnight in the intensive care unit (ICU) and transferred to a ward staffed by clinicians specialized in managing head and neck surgical patients
Summary
Introduction and backgroundIn the article that accompanies this paper we outline the importance of head and neck cancer and the critical role that surgery plays in its management. Seminal work starting in the 1990s showed the impact of clinical care pathways in improving the quality and cost of care in a broad range of conditions including head and neck cancer surgery. Previous studies of care pathways in head and neck surgery report short term outcomes and do not show the impact of a sustained quality management program on long-term outcomes. Most studies of CPs show they improve clinical outcomes but there is little known about the long-term impact of CPs as part of a sustained quality management program. Head and neck (HN) surgery with free flap reconstruction is complex, time-consuming and expensive. In this paper we report outcomes from a 9 year experience designing and using CPs in the management of patients undergoing major head and neck resection with free flap reconstruction
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