경추 전방 유합술 환자의 표준임상경로지(Critical Pathway) 개발

Abstract

[한글]본 연구는 국민들의 의료수준 향상과 서비스에 대한 욕구 증가, 서비스 질에 대한 병원간의 경쟁심화, DRG(Diagnosis Related Group) 지불제도에 따른 저비용, 고효율의 전략으로 새로운 건강관리 전달체계로써의 사례관리의 도입과 정착을 위한 일 예로 경추 전방 유합술을 시행 받은 환자를 대상으로 사례관리를 위한 표준임상경로지를 개발하는 것이다.

[영문]The purpose of this study is to develop a critical pathway for patients who are scheduled to have anterior cervical discectomy and fusion (ACDF). Studies suggested that the critical pathway can improve cost effectiveness of care, standardization of treatment, and patient satisfaction.

Initially, 9 concepts were identified as the framework of the critical pathway after reviewing literatures and the existing critical pathways. After reviewing 43 medical records of patients with ACDF who were hospitalized from January 1, 2008 to December 31, 2008, 24 medical records were selected as they followed more routine course of treatment.

Content validity of the preliminary critical pathway was tested by an expert group of 3 nurses, a nurse educator, and a physician and necessary revision was done. Final critical pathway was developed after the clinical validity of the revised version was done with 3 patients who received the ACDF from November 16th to 27th, 2009.

The results of the study are as follows;

1. The vertical axis of the critical pathway includes 8 categories: assessment, laboratory tests, treatments, consultation, activity level, medication, diet, teaching/discharge plan. The horizontal axis has the time frame from admission to discharge.

2. According the result of analysis of the 24 medical records used to develop preliminary critical pathway, the average hospitalization period was 11.54 days while the average period from admission to surgery was 3.83 days, and 8.58 days from surgery to discharge. After analyzing the service contents, it was decided that 2 days from admission to surgery and 5 days

from surgery to discharge.

3. The result of validity test of the preliminary critical pathway by the expert group showed that the 17 items had less than 86% consensus which were either deleted or revised.

4. The result of the clinical validity done with 3 patients showed that the average hospitalization period was 7.3 days, 2.3 days from admission to surgery, and 5 days from surgery to discharge. There were 1.2 days variations in admission to surgery and surgery to discharge days, but total days of hospitalization were 9 days. Also, route and type of medications were revised.

This is a methodological study developing a critical pathway for the patients having ACDF at one tertiary hospital in Seoul. Any implementation of this critical pathway will require careful evaluation to meet the specificity of each clinical setting.