Three years’ experience of collaborative care pathways on a maxillofacial ward

INTRODUCTION The aim of this study was to evaluate, within an NHS region, the process of care and the standard of record for orthognathic patients. PATIENTS AND METHODS A retrospective analysis of the medical records of 372 patients who underwent orthognathic surgery 1 January 1995 and 31 April 2000 in the South West Region of the UK. RESULTS Most patients underwent joint orthodontic and maxillofacial planning and had third molars extracted under general anaesthesia prior to orthognathic surgery. There was a significant difference in the median operation times and length of stay for bimaxillary surgery (4 h/4 days) compared with single jaw surgery (2 h/3 days; P < 0.001). Just over 15% of patients required removal of internal fixation plates after surgery, with nearly 90% of these requiring a further episode of general anaesthesia. The level of record keeping and patient review was variable with no regional standardisation. CONCLUSIONS This study is evidence of a generally acceptable standard in the process of care, which was found to follow international and national practices. However, at the time of the study there was no regional protocol for patient records or patient review, highlighting the need for the establishment of a regional database.

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“…12 The correlation (Fig. 1) between the length of operation and the length of stay was shown to be highly significant.…”

Section: Surgical Phasementioning

confidence: 86%

The process of orthognathic care in an NHS region

Parbatani¹,

Williams

Ireland

et al. 2010

annals

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“…The new millennium ushered in an era of increased interest in care pathways for head and neck oncologic procedures [7,10,13,[15][16][17][18]. These studies reported results from a variety of head and neck surgical procedures and some included patients undergoing major resection with free flap reconstruction.…”

Section: Discussionmentioning

confidence: 99%

The impact of a quality management program for patients undergoing head and neck resection with free-flap reconstruction: longitudinal study examining sustainability

Dort

Sauro

Chandarana

et al. 2020

J of Otolaryngol - Head & Neck Surg

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Background: Care pathways (CPs) are helpful in reducing unwanted variation in clinical care. Most studies of CPs show they improve clinical outcomes but there is little known about the long-term impact of CPs as part of a sustained quality management program. Head and neck (HN) surgery with free flap reconstruction is complex, time-consuming and expensive. Complications are common and therefore CPs applied to this patient population are the focus of this paper. In this paper we report outcomes from a 9 year experience designing and using CPs in the management of patients undergoing major head and neck resection with free flap reconstruction. Methods: The Calgary quality management program and CP design is described the accompanying article. Data from CP managed patients undergoing major HN surgery were prospectively collected and compared to a baseline cohort of patients managed with standard care. Data were retrospectively analyzed and intergroup comparisons were made. Results: Mobilization, decannulation time and hospital length of stay were significantly improved in pathwaymanaged patients (p = 0.001). Trend analysis showed sustained improvement in key performance indicators including complications. Return to the OR, primarily to assess a compromised flap, is increasing. Conclusions: Care pathways when deployed as part of an ongoing quality management program are associated with improved clinical outcomes in this complex group of patients.

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“…There has been an increased interest in the integration of care pathways into the care of patients undergoing head and neck oncologic procedures [13,15,16,[20][21][22][23]. The appeal of care pathways is supported by improvements in processes of care and clinical outcomes [5,6,17,24,25].…”

Section: Discussionmentioning

confidence: 99%

Designing and integrating a quality management program for patients undergoing head and neck resection with free-flap reconstruction

Dort

Sauro

Schrag

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

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Background: Care pathways (CPs) offer a proven method of systematically improving patient care. CPs are particularly helpful in complex clinical conditions where variation in care is a problem such as patients undergoing major head and neck resection with free flap reconstruction. Although CPs have been used to manage this patient group, most CPs are implemented as part of relatively short-term quality improvement projects. This paper outlines a detailed methodology for designing and delivering a quality management program sustained for 9 years. Methods: We describe a change management approach informed by Kotter's "8 Step Process" that provided a useful framework to guide program development and implementation. We then provide a detailed, step by step description of how such a program can be implemented as well as a detailed summary of time and costs for design, implementation and sustainability phases. An approach to design and delivery of a measurement, audit and feedback system is also provided. Results: We present a summary of resources needed to design and implement a head and neck surgery quality management program. The primary result of this study is a design for a sustainable quality management program that can be used to guide and improve care for patients undergoing major head and neck resection with free flap reconstruction. Conclusions: A change management approach to design and delivery of a head and neck quality management program is practical and feasible.

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Three years’ experience of collaborative care pathways on a maxillofacial ward

Cited by 16 publications

References 11 publications

The process of orthognathic care in an NHS region

The process of orthognathic care in an NHS region

The impact of a quality management program for patients undergoing head and neck resection with free-flap reconstruction: longitudinal study examining sustainability

Designing and integrating a quality management program for patients undergoing head and neck resection with free-flap reconstruction

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