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(Circulation. 1995;92:245-249.)
© 1995 American Heart Association, Inc.

Articles

Radical Outcome Method

A New Approach to Critical Pathways in Congenital Heart Disease

Kevin Turley, MD; Michael Tyndall, MD; Kerry Turley, RN, BSN, MPA; Dewey Woo, MD; Thomas Mohr, MD

From the Department of Cardiovascular Surgery, California Pacific Medical Center (Kevin Turley, Kerry Turley) and the Department of Pediatrics, Kaiser Permanente Medical Center (M.T., D.W., T.M.), San Francisco, Calif.

Background Treatment of congenital heart disease has entered a new era of healthcare delivery and cost containment. Critical pathway method (CPM) has been previously demonstrated by us to produce a significant reduction in average length of stay (ALOS) in hospital of -44%. A new approach, radical outcome method (ROM), has produced comparable results that appear to improve over time. The dynamic nature is examined.

Methods and Results Two hundred consecutive patients with congenital heart disease were treated by a single surgeon at a single health maintenance organization (HMO) facility. ROM was used in all patients. This method uses seven critical moments at which shortening rather than confirmation of the ALOS is possible. This process is completed by the second post-operative day. Overall mortality was 1%. The 200 patients were divided into two consecutive groups of 100 patients to determine the effectiveness of ROM over time. Fifty sets were matched. ALOS hospital decreased by 29 days (mean, 0.6 d/set), P<.003. Thirty sets who underwent cardiopulmonary bypass had a 16% decrease (P<.03), and 20 sets in whom nonbypass procedures were performed had a decrease of 16% (P<.02). ALOS in hospital for the 50 sets decreased from 3.7 to 3.1 days (-16%, P<.003). Outcome data demonstrated no significant difference.

Conclusions ROM, a proactive approach to hospital stay, is a dynamic process that reduces ALOS in hospital. This is achieved by both reducing negative variation in the standard CPM and allowing for positive variation. Outcome data confirm that this approach can reduce ALOS in hospital while providing optimal patient care and family satisfaction, a standard for the new era of healthcare delivery.

Key Words: pediatrics • quality assurance • critical pathways

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