Chang P L, Huang S T, Wang T M, Hsieh M L, Tsui K H
Department of Urology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
Eur Urol. 1998;33(6):523-8. doi: 10.1159/000019649.
The purpose of this study was to determine the effect on quality of care through the implementation of a clinical path for patients receiving transurethral prostatectomy.
We selected ten quality indicators with important clinical relevance as representative elements of the clinical path. These quality indicators were monitored during the entire hospitalization period of 100 consecutive patients who received transurethral prostatectomy. Monitoring data obtained from these patients were compared to data from 100 patients who received transurethral prostatectomy prior to implementation of the clinical path. Data was assessed to determine the relationship between quality indicators and management processes.
Implementation of the clinical path for transurethral prostatectomy significantly decreased the percent of patients with incomplete preoperative tests on admission day, the duration of intravenous antibiotics administration, the percent of patients who required acute pain management postoperatively, the percent of patients who received postoperative bladder irrigation with normal saline and the percent of patients who had their Foley catheter removed after postoperative day 2. Three of the quality indicators had a significant relationship with management processes and may have directly affected the total admission charges.
To evaluate the effect of the transurethral prostatectomy clinical path implementation on the quality of medical care, we compared ten quality indicators before and after implementation of this path. We concluded that implementation of the clinical path resulted in a statistically significant improvement in the quality of medical care.
本研究的目的是确定通过实施经尿道前列腺切除术临床路径对医疗质量的影响。
我们选择了十个具有重要临床相关性的质量指标作为临床路径的代表性要素。在连续100例接受经尿道前列腺切除术的患者的整个住院期间对这些质量指标进行监测。将从这些患者获得的监测数据与临床路径实施前接受经尿道前列腺切除术的100例患者的数据进行比较。对数据进行评估以确定质量指标与管理流程之间的关系。
经尿道前列腺切除术临床路径的实施显著降低了入院当天术前检查不完整的患者百分比、静脉使用抗生素的持续时间、术后需要急性疼痛管理的患者百分比、术后用生理盐水进行膀胱冲洗的患者百分比以及术后第2天之后拔除Foley导尿管的患者百分比。其中三个质量指标与管理流程有显著关系，可能直接影响了总住院费用。
为了评估经尿道前列腺切除术临床路径实施对医疗质量的影响，我们比较了该路径实施前后的十个质量指标。我们得出结论，临床路径的实施导致医疗质量有统计学意义的改善。
