A multidisciplinary team reviewed the current clinical practice involved in the care of patients admitted to our hospital for total laryngectomy with or without a neck dissection. The team consisted of 3 head and neck surgeons, a clinical nurse-manager, a clinical financial analyst, and representatives from the departments of speech and language pathology, nutritional services, physical and occupational therapy, pharmacy services, respiratory therapy, social work, and nursing. Biweekly meetings were attended by members of the team to identify patterns and areas of variance in the current clinical care for patients undergoing total laryngectomy. The team then developed a clinical pathway to provide care for this patient population in a "standardized" fashion. Input from each member of the team was considered in the development of the pathway, and the rationale for their recommendations was carefully evaluated by the whole team. Specific events outlined in the clinical pathway included preoperative workup and operating room equipment, supplies, and instrumentation. Postoperative care guidelines included time-specific events relating to recovery room care, intensive care unit (ICU) care, laboratory tests, ambulation, enteral feeding, management of drains and tubes, patient education, wound care, and medications. Guidelines for consultations, such as respiratory therapy, nutritional services, speech therapy, physical and occupational therapy, social work, and home nursing, were also outlined in the pathway. All of these patient-care events were plotted against a specified time frame, and an overall length of hospital stay was recommended. Variance from recommended pathway protocols was allowed based on individual patient needs but was clearly documented and monitored on a monthly basis. At 3-month intervals, a variance report was generated to identify patterns and causes of noncompliance, which were then addressed by pathway modification, personnel education, or both.