TY - JOUR
T1 - Impact evaluation of a Critical Pathway for patients with Clostridium difficile infection: a pre-post analysis in a Third Level Referral Center
AU - De Belvis, Antonio
AU - Barbara, Andrea
AU - Giubbini, Gabriele
AU - Traglia, Serena
AU - Angioletti, Carmen
AU - Ianiro, Gianluca
AU - Masucci, Luca
AU - Sanguinetti, Maurizio
AU - Laurenti, Patrizia
AU - Cambieri, Andrea
AU - Gasbarrini, Antonio
AU - Ricciardi, Walter
AU - Cammarota, Giovanni
PY - 2019
Y1 - 2019
N2 - BACKGROUND:
Clostridium Difficile Infections (CDIs) have been increasing both in incidence and in severity, representing a big public health concern.
AIM:
The aim of this study was to evaluate the impact of a recently implemented Critical Pathway (CP) focused on patients with CDI in an Italian Teaching Hospital.
METHODS:
The CP implementation consisted of intervention aimed to: faster diagnosis and appropriateness in admission and discharge point of care; activation of a multidisciplinary team; staff training; information to patients and caregivers. In a pre-post retrospective observational study, volume, process and outcome indicators were analyzed.
FINDINGS:
A total of 228 patients (128 in 2013 and 100 in 2016) were included. A decrease in the absolute number of access to the Emergency Department (p=0.02) and an increase in hospitalization in more appropriate ward (ie gastroenterology ward, p<0.001) were found. The median hospital length of stay decreased from 20.5 (12.5-31) days in 2013 to 16.5 (7-31) days in 2016 (p=0.05). With regards to outcome indicators, an increase of discharge to home and a decrease of discharge to long term facilities were showed (p=0.01 both). Despite a reduction, no statically significant differences in mortality between 2013 and 2016 were revealed by the analysis.
CONCLUSION:
In conclusion, we found out a quality improvement in patient hospital management. Our experience confirms that the implementation of the CP increases the appropriateness in hospital quality of care.
AB - BACKGROUND:
Clostridium Difficile Infections (CDIs) have been increasing both in incidence and in severity, representing a big public health concern.
AIM:
The aim of this study was to evaluate the impact of a recently implemented Critical Pathway (CP) focused on patients with CDI in an Italian Teaching Hospital.
METHODS:
The CP implementation consisted of intervention aimed to: faster diagnosis and appropriateness in admission and discharge point of care; activation of a multidisciplinary team; staff training; information to patients and caregivers. In a pre-post retrospective observational study, volume, process and outcome indicators were analyzed.
FINDINGS:
A total of 228 patients (128 in 2013 and 100 in 2016) were included. A decrease in the absolute number of access to the Emergency Department (p=0.02) and an increase in hospitalization in more appropriate ward (ie gastroenterology ward, p<0.001) were found. The median hospital length of stay decreased from 20.5 (12.5-31) days in 2013 to 16.5 (7-31) days in 2016 (p=0.05). With regards to outcome indicators, an increase of discharge to home and a decrease of discharge to long term facilities were showed (p=0.01 both). Despite a reduction, no statically significant differences in mortality between 2013 and 2016 were revealed by the analysis.
CONCLUSION:
In conclusion, we found out a quality improvement in patient hospital management. Our experience confirms that the implementation of the CP increases the appropriateness in hospital quality of care.
KW - Clostridium Difficile infection
KW - critical pathways
KW - patient centeredness
KW - Clostridium Difficile infection
KW - critical pathways
KW - patient centeredness
UR - http://hdl.handle.net/10807/129552
U2 - 10.1016/j.ijid.2019.01.025
DO - 10.1016/j.ijid.2019.01.025
M3 - Article
SN - 1201-9712
SP - N/A-N/A
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
ER -
