Williams B A, DeRiso B M, Engel L B, Figallo C M, Anders J W, Sproul K A, Ilkin H, Harner C D, Fu F H, Nagarajan N J, Evans J H, Watkins W D
Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh Medical Center, Montefiore University Hospital, PA 15213-2582, USA.
J Clin Anesth. 1998 Nov;10(7):561-9. doi: 10.1016/s0952-8180(98)00082-8.
(1) To introduce anesthesia clinical pathways as a management tool to improve the quality of care; (2) to use the Procedural Times Glossary published by the Association of Anesthesia Clinical Directors (AACD) as a template for data collection and analysis; and (3) to determine the effects of anesthesia clinical pathways on surgical processes, outcomes, and costs in common ambulatory orthopedic surgery.
Hospital database and patient chart review of consecutive patients undergoing anterior cruciate ligament reconstruction (ACLR) during academic years (AY) 1995-1996 and 1996-1997. Patient data from AY 1995-1996, during which no intraoperative anesthesia clinical pathways existed, served as historical controls. Data from AY 1996-1997, during which intraoperative anesthesia clinical pathways were used, served as the treatment group. Regional anesthesia options were routinely offered to patients in the clinical pathway.
Ambulatory surgery center in a teaching hospital.
The records of 503 ASA physical status I and II patients were reviewed. 1996-1997 patients underwent clinical pathway anesthesia care in which the intraoperative and postoperative anesthesia process was standardized with respect to symptom management, drugs, and equipment used. 1995-1996 patients did not have a standardized intraoperative and postoperative anesthetic course with respect to the management of common symptoms or to specific drugs and supplies used. Intervals described in the AACD Procedural Times Glossary, anesthesia drug and supply costs, and patient outcome variables (postoperative nursing interventions required and unexpected admissions), as influenced by the use of the anesthesia clinical pathway, were measured. Clinical pathway anesthesia care of ACLR in 1996-1997, which actively incorporated regional anesthesia options, reduced pharmacy and materials cost variability; slightly increased turnover time; improved intraoperative anesthesia and surgical efficiency, recovery times, and unexpected admission rates; and decreased the number of required nursing interventions for common postoperative symptoms.
Clinical pathway patient management systems in anesthesia care are likely to produce useful outcome data of current practice patterns when compared with historical controls. This management tool may be useful in simultaneously containing costs and improving process efficiency and patient outcomes.
（1）引入麻醉临床路径作为一种管理工具，以提高医疗质量；（2）使用麻醉临床主任协会（AACD）发布的《手术时间术语表》作为数据收集和分析的模板；（3）确定麻醉临床路径对常见门诊骨科手术的手术过程、结果和成本的影响。
对1995 - 1996学年和1996 - 1997学年连续接受前交叉韧带重建（ACLR）手术的患者进行医院数据库和病历审查。1995 - 1996学年期间没有术中麻醉临床路径，该期间的患者数据作为历史对照。1996 - 1997学年期间使用了术中麻醉临床路径，该期间的患者数据作为治疗组。临床路径中的患者常规可选择区域麻醉。
一家教学医院的门诊手术中心。
对503例ASA身体状况为I级和II级的患者记录进行了审查。1996 - 1997学年的患者接受了临床路径麻醉护理，其中术中及术后麻醉过程在症状管理、用药和设备使用方面实现了标准化。1995 - 1996学年的患者在常见症状管理或特定药物及用品使用方面没有标准化的术中及术后麻醉过程。测量了AACD《手术时间术语表》中描述的时间间隔、麻醉药物和用品成本以及患者结局变量（所需的术后护理干预和意外入院情况），这些变量受麻醉临床路径使用的影响。1996 - 1997学年ACLR的临床路径麻醉护理积极纳入了区域麻醉选择，降低了药房和材料成本的变异性；略微增加了周转时间；提高了术中麻醉及手术效率、恢复时间，并降低了意外入院率；减少了常见术后症状所需的护理干预次数。
与历史对照相比，麻醉护理中的临床路径患者管理系统可能会产生有关当前实践模式的有用结局数据。这种管理工具可能有助于同时控制成本并提高流程效率和患者结局。
