P-0044 A Development and Application of a Standardized Critical Pathway for Stomach Endoscopic Submucosal Resection and Colon Endoscopic Mucosal Resection Patients

Abstract Introduction Medical services face to trend toward increasing their efficacies and patient's satisfactions and decreasing the medical costs at the same time. Critical pathway (CP) has been suggested to figure it out. Previous reports showed that CP has these goals improve in surgical treatments such as appendectomy. However, CP in medical treatment like the endoscopic procedures did not. This study is to evaluate the efficacy and safety of Critical Pathway of Stomach Endoscopic Submucosal Dissection and Colon Endoscopic Mucosal Resection Methods Data were obtained from medical and paramedical records at Seoul National University Hospital (SNUH). The basic research design is a retrospective case-control comparative study. From June 2009 to August 2009, 86 and 34 patients were enrolled in Critical Pathway group (CP group) for Stomach Endoscopic Submucosal Resection (ESD) and Colon Endoscopic Mucosal Resection (EMR), respectively at SNUH. Whereas, non-Critical Pathway group (non-CP group) was composed of the patients who had undergone ESD or EMR from June 2009 to August 2009 at same hospital (n=71, 18, respectively). Average hospital stay days, average total medical expenses, average per day medical expenses, treatment related complication rates and satisfaction rates by questionnaire were analyzed between both groups. Results The average hospital stay days were decreased 0.6 (ESD) and 1.1 days (EMR) which had statistical significance in CP group. The tendency was observed that average total medical expenses were decreased and average per day medical expenses were increased in CP group. However, in case of ESD, average total medical expenses in CP group were higher than that in non-CP group. Complication rates showed no significant difference between both groups. Satisfaction rates displayed over 90% after application of critical pathway. Conclusion The application of Critical Pathway demonstrates efficacy and safety for Stomach ESD and Colon EMR in view of hospital stay, costs and complication.