Implementation of a web-based clinical pathway for radical nephrectomy to improve health outcomes

Radical nephrectomy is a conventional method of treating patients with renal cell carcinoma. The implementation of clinical pathways has been used to monitor health outcomes. Recently, many advantages of web-based technologies have been reported. Therefore, this study develops a web-based clinical pathway for radical nephrectomy and applies it to improve patient care quality. The web-based clinical pathway for radical nephrectomy was a daily special form that scheduled consultation, discharge plan, elimination, medication, nutrition, psychosocial support, teaching, laboratory test, treatment, and variance times. Daily patient activities were tracked via the web-based clinical pathway. The clinical pathway variations were identified and recorded using the Internet. Following patient discharge, the web-based clinical pathway was completed and the results were stored on the web server. The analyzed data, including variations, then were e-mailed to the clinical physicians and nurses for reference. From July 2000 to August 2001, 63 consecutive patients with renal cell carcinoma were treated using the web-based clinical pathway for radical nephrectomy. After implementing the web-based clinical pathway, the mean hospital stay reduced significantly from 11.4 to 9.9 (p = 0.0063) days compared to before clinical pathway implementation. Average admission charges also reduced significantly (p = 0.0075). The percentage of patients with variances reduced from 38.3% to 23.8% (p = 0.232) compared to the first-year paper-based pathway. Notably, no significant differences were noted in variances between the web-based and paper-based pathways. However, the variance detection time in the web-based implementation was significantly (p = 0.0162) less than that in the paper-based pathway. A previous report confirmed the improvement in care quality when using a paper-based clinical pathway. The web-based clinical pathway improved care quality by a quantity equal to that reported for the paper-based pathway in 2002. In this study, one of the four quality indicators was continuously improved (p = 0.0006) in the implementing webbased pathway. Additionally, the web-based clinical pathway captured the data directly in an electronic format, facilitating and accelerating analysis. Implementation of a web-based clinical pathway for radical nephrectomy can improve health outcomes by reducing mean hospital stay and average admission charges, and by improving care quality. Such a web-based pathway is as efficient as the paper-based pathway. However, the web-based clinical pathway is superior to the paper-based pathway in variance detection.