Integrated Care Pathways for Vascular Surgery: an Analysis of the First 18 Months

Objectives: A review of the use of previously described integrated care pathways (ICPs) established for three elective vascular surgical procedures.

Design: A retrospective analysis of information gathered prospectively over an initial 18 month period of use of vascular surgical ICPs.

Subject: Patients admitted to a single vascular unit for "open" repair of abdominal aortic aneurysm (AAA), carotid endarterectomy, or femoropopliteal bypass grafting.

Methods: An analysis of variance data, length of stay, and costings after the use of ICPs, compared with previous clinical practice.

Results: Variance data were gathered for each of the three procedures. Variances of medication prescribing and delays in discharge were common to all procedures. In particular: (i) gastrointestinal complications were more specific to AAA repair and (ii) wound drains were removed a day later than originally proposed after femoropopliteal bypass. Overall, improved efficiency due to use of ICPs reduced the length of stay for all procedures, which was reflected in a potential cost saving of some 25%.

Conclusion: There are clear benefits to the use of ICPs, resulting in more structured, efficient, and cost effective patient care. Recommended changes to current practice based on variance analysis will require continued audit to sustain this "evidence based" approach.