Implementation of a Critical Pathway for Complicated Gallstone Disease: Translation of Population-Based Data into Clinical Practice

NIH Public Access Author Manuscript J Am Coll Surg. Author manuscript; available in PMC 2012 May 11.

NIH-PA Author Manuscript

Published in final edited form as: J Am Coll Surg. 2011 May ; 212(5): 835–843. doi:10.1016/j.jamcollsurg.2010.12.047.

Implementation of a Critical Pathway for Complicated Gallstone Disease: Translation of Population-based Data into Clinical Practice Kristin M. Sheffield, Ph.D.1, Kenia E. Ramos, R.N.1, Clarisse D. Djukom, M.D.1, Carlos J. Jimenez, M.D., FACS1, William J. Mileski, M.D., FACS1, Thomas D. Kimbrough, M.D., FACS1, Courtney M. Townsend Jr., M.D., FACS1, and Taylor S. Riall, M.D., Ph.D., FACS1 1Department of Surgery, The University of Texas Medical Branch, Galveston, TX

Abstract NIH-PA Author Manuscript

BACKGROUND—Evidence-based guidelines recommend cholecystectomy during initial hospitalization for complicated gallstone disease. Previous studies as well as quality initiative data from our institution demonstrated that only 40–75% of patients underwent cholecystectomy on index admission. STUDY DESIGN—In January 2009, we implemented a critical pathway to improve cholecystectomy rates for all patients emergently admitted for acute cholecystitis, mild gallstone pancreatitis, or common bile duct stones. We compared cholecystectomy rates during initial hospitalization, time to cholecystectomy, length of initial stay (LOS), and readmission rates in prepathway (1/05–2/08) and post-pathway patients (1/09–5/10). RESULTS—Demographic and clinical characteristics were similar between pre-pathway (n=455) and post-pathway patients (n=112). Cholecystectomy rates during initial hospitalization increased from 48% to 78% after pathway implementation (P