gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Chances and possibilities using "Clinical Pathways". An economic and medical point of view: An example of lumbar disc herniation

Chancen und Möglichkeiten "Klinischer Patientenpfade". Eine ökomomische und medizinische Betrachtung am Beispiel des lumbalen Bandscheibenvorfalls

Meeting Abstract

Search Medline for

  • corresponding author Armin Helmbrecht - Klinik für Neurochirurgie, Klinikum Augsburg, Augsburg
  • V. Heidecke - Klinik für Neurochirurgie, Klinikum Augsburg, Augsburg

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocDI.01.12

The electronic version of this article is the complete one and can be found online at:

Published: April 23, 2004

© 2004 Helmbrecht et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




With the changes of the financing structure in the german health system by introducing the G-DRG, the necessity of knowing our processes and process costing became more important. We decided after an ABC-analysis of our clinic portfolio to implement a clinical pathway "lumbar disc herniation" for a better controlling and a better strategy in portfolio management.


An analysis of the used common pathway was combined with its procedures and there costs. For a data basis was used the electronic operation book, the business reports of the hospital, the OP-documentation-system (Carus) and the patient data management program (Medico S). In a second step a optimized pathway was defined and implemented. The results are compared to "own practise sector"-data called in germany Belegbetten and to international european data, like the north DRG countries Finnland and Sweden and in addition Switzerland.


The improved and implemented clinical pathway "lumbar disc herniation" is in consideration of duration of stay in the age of G-DRG in the neurosurgical portfolio still a "cash-cow". A clinical pathway allows a bottom up calculation our procedures and it is in contrast to the top-down financing system of DRG quite important. The costs for the treatment of a lumbar disc herniation in germany is in the european field still in the middle without any leck of quality and still with the longest duration of stay in the hospital. Compared with the "own practise sector" of the german system there is from a hospital management point of view no longer need to employ any neurosurgeon or orthopedic surgeon.


Clinical pathways are nessesary for process costing, - analysing and - optimizing. The economical data provid the basis for an efficient controlling. It also allows a benchmarking with other clinics and give us the chance to learn from the susposed best. From the medical point of view it is a useful tool for risk- and quality management. Especisally when the pathway is derived from a national guideline and is under permanent controll in a PDCA-cyclus. Further up it is helpful for certification or accreditation like for example KTQ. It is also a nessesary tool to develop an efficient sector overlapping care ("managed care") like it is demanded by the political authorities.