The Importance of Variance Analysis in use of a Clinical Path

Hitoshi Sekido, Yasuhiko Nagano, Yasuhiko Miura, Toru Kubota, Itaru Endo, Shinji Togo and Hiroshi Shimada

Department of Surgery II, Yokohama City University, School of Medicine

We studied the impact of variance analysis on the clinical path (CP) in laparoscopic cholecystectomy. Implementing the CP enabled us to shorten hospital stay and increase hospital income. We found 18 variations in 17 CPs, 72.2% of which occurred in the first 6 CPs. We categorited reasons for the 18 variations as follows: patient-related, 8; staff-related, 10; hospital-related, 0; and social factors, 0. Patient-related variances in6cases were due to physical problems. Two others were related to patient mental health. The remaining 10 variations were staff-related all due to unnecessary orders by individual doctors. The frequency of variations decreased with doctors' experience and understanding of the CP. These doctors evaluated their treatment strategy compared to the CP, and the CP and its outcome should continue to be evaluated and discussed.

Key words
clinical path, laparoscopic cholecystectomy, variance

Reprint requests
Hitoshi Sekido Department of Surgery II, Yokohama City University, School of Medicine 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004 JAPAN

Accepted
October 31, 2001

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