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Impact of a clinical pathway in cases of transurethral resection of the prostate.

Due to the recent dramatic increase in health care costs, costs containment for medical care has been recognized as an important issue. We evaluated the effects of a clinical pathway on hospital charges and the clinical outcome. The subjects consisted of 48 patients who underwent transurethral resection of the prostate (TUR-P) at the Department of Urology, Nerima General Hospital via its own clinical pathway during the two-year period from April 1998 to March 2000. The mean length of hospital stay, clinical outcome and the medical insurance charges for these patients were compared with those of 68 patients who had undergone TUR-P before the implementation of the clinical pathway. As a result of the clinical pathway implementation for TUR-P, the length of hospital stay decreased from 17.2 days to 3.8 days and the total medical insurance charges (insurance points) also decreased from 37,484.6 to 31,278.9 yen. The postoperative complications did not substantially differ before and after the implementation of the clinical pathway. These results demonstrate that the establishment of clinical pathway can improve the treatment efficiency for almost all patients. It is, however, important to take into account the individuality of patients.