Original Contributions
*Assistant Professor of Anesthesiology
†Associate Professor of Anesthesiology
‡Research Assistant
§Project Manager, Surgical Services Informa-
tion Systems
Professor of Orthopedic Surgery
#
Professor and Chairman, Department of
Orthopedic Surgery
**Associate Professor, University of Pitts-
burgh Katz Graduate School of Business
††Professor, University of Pittsburgh Katz
Graduate School of Business
‡‡Professor of Anesthesiology; Medical Di-
rector, Clinical Trials Program
Address correspondence to Dr. Williams at
the Department of Anesthesiology and Crit-
ical Care Medicine, University of Pittsburgh
Medical Center, NW–463, Montefiore Uni-
versity Hospital, 200 Lothrop St., Pittsburgh,
PA 15213–2582, USA.
Supported by the Society for Ambulatory
Anesthesia’s Young Investigator Award
1996–1997, Park Ridge, IL; the Anesthesiol-
ogy News Cost Effectiveness Award, 1995,
New York, NY; and the University of Pitts-
burgh Department of Anesthesiology and
Critical Care Medicine Seed Grant, 1997,
Pittsburgh, PA.
Received for publication December 2, 1997;
revised manuscript accepted for publication
July 14, 1998.
Benchmarking the
Perioperative Process: II.
Introducing Anesthesia
Clinical Pathways to Improve
Processes and Outcomes and
to Reduce Nursing Labor
Intensity in Ambulatory
Orthopedic Surgery
Brian A. Williams, MD, MBA,*
Barbara M. DeRiso, MD,† Lori B. Engel,‡
Chiara M. Figallo, BS,‡ Joel W. Anders, BS,‡
Kari A. Sproul, BS,‡ Hakan Ilkin, MBA,§
Christopher D. Harner, MD,
ሻ
Freddie H. Fu, MD,
#
Nandu J. Nagarajan, PhD,**
John H. Evans, III, PhD,††
W. David Watkins, MD, PhD‡‡
Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh
Medical Center, Pittsburgh, PA
Study Objectives: (1) To introduce anesthesia clinical pathways as a management tool
to improve the quality of care; (2) to use the Procedural Times Glossary published by the
Association of Anesthesia Clinical Directors (AACD) as a template for data collection and
analysis; and (3) to determine the effects of anesthesia clinical pathways on surgical
processes, outcomes, and costs in common ambulatory orthopedic surgery.
Design: Hospital database and patient chart review of consecutive patients undergoing
anterior cruciate ligament reconstruction (ACLR) during academic years (AY) 1995–
1996 and 1996–1997. Patient data from AY 1995–1996, during which no intraoper-
ative anesthesia clinical pathways existed, served as historical controls. Data from AY
1996–1997, during which intraoperative anesthesia clinical pathways were used, served
as the treatment group. Regional anesthesia options were routinely offered to patients in the
clinical pathway.
Setting: Ambulatory surgery center in a teaching hospital.
Measurements and Main Results: The records of 503 ASA physical status I and II
patients were reviewed. 1996 –1997 patients underwent clinical pathway anesthesia care
Journal of Clinical Anesthesia 10:561–569, 1998
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