• J Sloan, K Chatterjee, T Sloan, G Holland, M Waters, D Ewins, and N Laundy.
• Department of Emergency Medicine, Countess of Chester Hospital, Liverpool Road, Chester CH2 1UL, UK. john.sloan@coch.nhs.uk
• Emerg Med J. 2009 Jul 1;26(7):479-83.

BackgroundPathways to guide clinical care are well accepted and used in many emergency departments. We wanted to introduce a number ("bundle") over a short space of time and involve the whole patient stay in the pathway. It was hypothesised that a more efficient process would result with an overall reduction in length of stay (LoS).MethodsA "bundle" of 14 evidence-based pathways of care was introduced into a medium-sized district general hospital (DGH) in late 2006/early 2007. These pathways covered emergency department care and acute medical care for a period of up to 48 h. A total of 8184 acute emergency admission episodes were audited, 3852 in the 8 months before introduction of the new pathways and 4332 in the 8 months after their introduction.ResultsThe overall effect of introducing the pathway bundle had a trend towards reduction in LoS by 0.2 days (95% CI -0.2 to 0.5), but this was not statistically significant (p>0.1). However, in those patients with ConclusionThe introduction of a bundle of evidence-based care pathways can modestly reduce LoS for certain types of acute medical patients in a DGH setting.

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