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Effects of a clinical pathway on quality of care in kidney transplantation: a non-randomized clinical trial

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Abstract

Purpose

Standardization of care is essential for improving outcome of kidney transplantation (KT). Clinical pathways (CPs) are known to standardize and improve perioperative care for a number of interventions. In transplantation medicine, however, pertinent evidence is very limited. This study evaluates effects of a CP on quality of care in KT.

Materials and methods

Consecutive patients (n = 32) undergoing KT between July 2006 and August 2007 who were treated with a CP were compared to patients (n = 44) treated without CP between January 2005 and June 2006. Several quality indicators regarding process and outcome were compared between groups.

Results

Quality of care was significantly higher in the CP group for the following indicators: timely removal of central venous catheters, wound drains, and Foley catheters and control of cyclosporine levels, respiratory exercising, and pain control. Median stay decreased non-significantly from 21.4 to 18.3 days. There was significantly less delayed graft function in the CP group. All other outcome indicators showed no significant differences.

Conclusions

Implementation of a CP for KT improves the quality of perioperative treatment by standardizing care. Regarding effects on outcome, no clear conclusion can be drawn. We recommend that large randomized studies are conducted to evaluate the latter issue.

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Acknowledgments

We thank Klaus Meyer, Angela Cepancic, and the whole nursing team for their invaluable help in designing and implementing the CP. We thank the German Society for Process Management (DGKPM) for supporting this project.

Author information

Authors and Affiliations

  1. Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, 68135, Mannheim, Germany

    Matthias Schwarzbach, Roderich Bönninghoff, Katrin Harrer, Johannes Weiss, Stefan Post & Ulrich Ronellenfitsch

  2. Department of Anaesthesiology and Operative Critical Care Medicine, University Medical Centre Mannheim, Mannheim, Germany

    Christof Denz

  3. Department of Nephrology, Endocrinology and Rheumatology, University Medical Centre Mannheim, Mannheim, Germany

    Peter Schnülle & Rainer Birck

Authors
  1. Matthias Schwarzbach
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  2. Roderich Bönninghoff
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  3. Katrin Harrer
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  4. Johannes Weiss
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  5. Christof Denz
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  6. Peter Schnülle
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  7. Rainer Birck
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  8. Stefan Post
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  9. Ulrich Ronellenfitsch
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Corresponding author

Correspondence to Matthias Schwarzbach.

Additional information

M. Schwarzbach and R. Bönninghoff contributed equally to the paper.

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Schwarzbach, M., Bönninghoff, R., Harrer, K. et al. Effects of a clinical pathway on quality of care in kidney transplantation: a non-randomized clinical trial. Langenbecks Arch Surg 395, 11–17 (2010). https://doi.org/10.1007/s00423-009-0551-3

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  • DOI: https://doi.org/10.1007/s00423-009-0551-3

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