BACKGROUND: Clinical pathways are structured, multidisciplinary plans of care that provide detailed guidance for each stage in the management of a patient with a specific clinical problem. They aim to link evidence-based medicine to national clinical guidelines to improve patient care.
OBJECTIVE: To assess the effect of a clinical pathway applied among children and adolescents with newly diagnosed type 1-diabetes.
METHODS: This is a prospective internal quality control study at the child and adolescent ward at Oslo University Hospital, Ullevål. 60 patients admitted to the ward with newly diagnosed type 1-diabetes are included in the study; 30 patients before the implementation of the clinical pathway (group 1), and 30 patients afterwards (group 2). The parameters that are investigated are length of stay (LOS) in the hospital, HbA1c-value 12 months after admission, the occurrence of ketoacidosis and/or severe hypoglycemia, and patient satisfaction. Each patient was followed for one year.
RESULTS: The median LOS (+95% CI) in group 2 was shorter than in group 1, 10 (9-12) days versus 12 (11-12) days respectively. Mean HbA1c-value (+95% CI) after 12 months was 7,7 (7,3-8,0) % in group 1, and 8,0 (7,5-8,4) % in group 2; this difference of 0,3 % is not statistically significant. There was no statistically significant change in patient satisfaction and the number of ketoacidosis/severe hypoglycemia among the two groups.
CONCLUSIONS: The implementation of the clinical pathway led to significant reduction in the length of stay at the hospital. It did not reduce an already high patient satisfaction, nor led to poorer metabolic control.