BACKGROUND: : Clinical Standard Work (CSW) aims to improve quality of care through standardization based on evidence in medical literature and/or expert opinion. We hypothesize that implementing such a pathway for bladder exstrophy patients at our institution will improve outcomes.
METHODS: : A comprehensive literature search was performed. Of 777 records screened, 15 papers were included in pathway development by a multidisciplinary group. High volume bladder centers were also surveyed regarding management. We compared pre implementation outcomes data for 22 patients from 2014-2018 to post implementation data for 20 patients from 2018-2023
RESULTS: CSW protocols were developed spanning prenatal diagnosis, neonatal admission, pre-operative evaluation, intra operative management and post operative care. Average hospital stay decreased from 7.6 days to 5 days. Thirty day readmission rate decreased from 30% to 10.5%. Moreover newborns with bladder exstrophy were successfully managed at their birthing institutions without transfer to a tertiary care center. Laboratory costs decreased from an average of $2951 to $1559. Pharmacy costs were reduced from $7646 to $4849.
CONCLUSIONS: Care of bladder exstrophy patients can be standardized using evidence based and best practice pathways. These pathways decrease variation, improve patient education and result in decreased hospital stay, decreased readmissions and decreased cost. These pathways can be updated regularly based on available new evidence such as adding Enhanced Recovery Protocols that have been recently implemented in the pathway 
