重要的不是你做了什么，而是你做事的方式：阑尾炎护理路径的影响。

It is not what you do, it is the way that you do it: impact of a care pathway for appendicitis.

作者信息

Almond Sarah L, Roberts Megan, Joesbury Victoria, Mon Sue, Smith Jeff, Ledwidge Nevila, Pisipati Sailaja, Khan Amir, Khalil Basem A, White Elvina, Baillie Colin T, Kenny Simon E

机构信息

Department of Paediatric Surgery, Royal Liverpool Children's NHS Trust, L12 2AP Liverpool, UK.

出版信息

J Pediatr Surg. 2008 Feb;43(2):315-9. doi: 10.1016/j.jpedsurg.2007.10.019.

DOI:10.1016/j.jpedsurg.2007.10.019

PMID:18280281

Abstract

BACKGROUND/PURPOSE: Appendicitis is the most common surgical emergency in children. However, management varies widely. The aim of this study was to assess the impact of introducing a care pathway on the management of childhood appendicitis.

METHODS

Data were collected prospectively for 3 successive cohorts: All patients operated for suspected appendicitis were included. The pathway was modified after interim analysis of group B data. P < .05 was significant.

RESULTS

Six hundred patients were included. When compared with group A, group C patients were more likely to receive preoperative antibiotics (P < .0001), undergo formal pain assessment (P < .0001), and be operated before midnight (P = .025). There was a significant decrease in readmission rates from 10.0% to 4.2% (P = .023) despite an increase in cases of gangrenous and perforated appendicitis (P = .010).

CONCLUSIONS

The introduction of a care pathway resulted in improved compliance with antibiotic regimens, more frequent pain assessment, and fewer post-midnight operations. Postappendicectomy readmission rates were reduced despite an increase in disease severity. This was achieved by critical reevaluation of outcomes and pathway redesign where appropriate.

摘要

背景/目的：阑尾炎是儿童最常见的外科急症。然而，其治疗方法差异很大。本研究的目的是评估引入一种护理路径对儿童阑尾炎治疗的影响。