Tallis G, Balla J I
Box Hill-Monash Quality Healthcare Education Unit, Box Hill Hospital, Melbourne.
Aust J Public Health. 1995 Apr;19(2):155-9. doi: 10.1111/j.1753-6405.1995.tb00366.x.
The aim of this study was to determine the effect of a critical path analysis, used as a management tool, on the efficiency of clinical service delivery for patients with a fractured neck of femur. It is a before-and-after study of the medical records of all patients admitted between October 1992 and October 1993 with a primary diagnosis of fractured neck of femur, but excluding patients under 50 years old and those with multiple fractures or metastatic disease. Patients fell into two groups: those admitted in the six months before the introduction of a clinical management program based on a critical path analysis, and those admitted after the introduction of the program in April 1993 (88 program cases and 90 nonprogram cases). A medical records administrator blinded to the program category of the patients independently coded diagnostic data, while other data were abstracted from the clinical notes. The length of stay for a fractured neck of femur declined from a mean of 19.3 days to a mean of 11.0 days (P < 0.0001). The outcome measures were: the distance walked just before discharge from hospital, the discharge destination, and unplanned readmission. These did not change significantly, and the wound infection rate declined during the period of the intervention. The implementation of a clinical management pathway based on a critical path analysis dramatically reduced the length of stay for patients admitted with a fractured neck of femur while maintaining quality of outcomes. Critical path analysis is a useful management tool to improve the efficiency of certain clinical services.
本研究的目的是确定作为一种管理工具的关键路径分析对股骨颈骨折患者临床服务提供效率的影响。这是一项对1992年10月至1993年10月期间所有以股骨颈骨折为主要诊断入院患者的病历进行的前后对照研究，但不包括50岁以下患者以及患有多发性骨折或转移性疾病的患者。患者分为两组：一组是在基于关键路径分析的临床管理计划引入前六个月入院的患者，另一组是在1993年4月该计划引入后入院的患者（88例计划组病例和90例非计划组病例）。一名对患者的计划类别不知情的病历管理员独立对诊断数据进行编码，而其他数据则从临床记录中提取。股骨颈骨折患者的住院时间从平均19.3天降至平均11.0天（P<0.0001）。结果指标包括：出院前行走的距离、出院目的地和非计划再入院情况。这些指标没有显著变化，且在干预期间伤口感染率有所下降。基于关键路径分析实施临床管理路径可显著缩短股骨颈骨折入院患者的住院时间，同时维持治疗效果质量。关键路径分析是提高某些临床服务效率的一种有用管理工具。
