Dynamic patient management in combination with clinical pathways is an effective tool to optimize clinical resources in cardiovascular surgery

Objective: Hospital expenses are a major part of healthcare costs in industrialized countries. Consequently, hospitals are obliged to offer highest-quality patient care as inexpensively as possible. A management system was implemented in a university hospital department of cardiovascular surgery in cooperation with Porsche Consulting and McKinsey to improve quality of patient-care and cost effectiveness.

Method: All schedule-related patient information was centralized to a single „patient-manager“ in order to put a maximum of patients on defined clinical pathways. Time and length of stay, surgical procedure, and intensive-care sojourn time were estimated in advance by an experienced cardiac surgeon and integrated in the Prometheus®-system. Continuous updates of patient-related information, structured scheduling management, and consequent controlling are part of the system.

Results: 1505 patients (100%) were admitted from 5/2005 to 6/2006. 1083 patients (71.9%) were scheduled in advance, 422 emergency patients (28.1%) were admitted without prior appointment. No scheduled admission was delayed or cancelled. Delay of scheduled elective surgery occurred only in 34 patients (2.6%). Patients on clinical pathways remained mostly on the paths (90.2%). There was no need anymore to claim ward-capacity temporarily outside the department. Medium total length of stay fell from 11.4 to 9.6 days. Thus, material and personnel expenses dropped by 10%, while patient turnover increased.

Conclusion: A linked system of clinical pathways and dynamic patient-management was introduced successfully. Though emergency patients do affect operating room and intensive-care unit resources, the system provides reliable schedules. Consecutively, utilization of hospital resources was optimized and employee and patient satisfaction is enhanced.