小兒腹股溝疝氣修補術臨床路徑的發展及應用

The Development and Implementation of the Clinical Pathway: Pediatric Femoral and Inguinal Hernia Repair

李雅玲(Ya-Ling Lee) ； 李宜蓉(I-Jong Lin) ； 施富金(Fu-Jin Shih) ； 黃金蓮(Chin-Lian Huang)

《慈濟醫學雜誌》 12卷3期 (2000/09) Pp. 191-196

https://doi.org/10.6440/TZUCMJ.200009.0191

摘要

目的：研究臨床路徑的發展與實施，以及在醫療成本控制、病患住院日數、醫療品質變異控制、文書記錄時間、及護理標準的影響。材料與方法：本研究以台北某醫學中心為研究場所，先發展臨床路徑並進行臨床測試之後，進入試用階段，再次經過評估而成為正式病歷；研究樣本為臨床路徑實施前一年（86.7-87.6，共得230個案）接受腹股溝疝氣修補的兒童，並請護理人員對於臨床路徑實施給予評值。結果：1.可降低病童住院日數，實施臨床路徑前平均住院日數為3.22天，實施臨床路徑後平均住院日數為1.98天，減少1.24天；2.節省醫院的醫療成本花費，共節省平均住院費用35元、藥費329元、手術費324元；3.降低臨床護理人員的文書工作負荷，記錄時間從原先3.3分/班降為1.8分/班；4.可監測此路徑的變異狀況以確保病童獲得較高的醫療品質；5.並建立護理標準使護理工作所依循，研究對象中有92.6%的護理人員對於路徑單取代護理記錄感到滿意。結論：臨床路徑的實施，的確有助醫院面對全民建保於1995年施行後的醫療變動，尤其是在成本效益的控制、監測、提供標準化的醫療服務、減少護理文書記錄時間、及確保病患的醫療品質方面，是值得肯定及推行的政策。

關鍵字

疝氣 ； 臨床路徑 ； 成本效益 ； 醫療品質 ； 護理標準

並列摘要

Objective: This research was to study the development and effects of a clinical pathway, in these aspects of medical expenses, length of stay in the hospital, quality of medical care, record-keeping workload, and establishment of nursing standard. Materials and Methods: Consistent with such goals, we established a clinical pathway for Pediatric Femoral and Inguinal Hernia Repaired Surgery. Retrospective and prospective survey were used to study two patient groups: 221 cases were collected from one year duration before clinical pathway adopted, 230 cases from one year duration after clinical pathway adopted. Results: Implementation of the Pediatric Femoral and Inguinal Hernia Repaired Surgery pathway included: 1. Shortening the hospital stay for children (from 3.22 days to 1.98 days). 2. Decreasing in medical expenses (drug expenses from 812 NT dollars to 483 NT dollars/case). 3. Decreasing record record-keeping workload for nursing staff (from 3.3 min to 1.8 min/shift for each patient). 4. Monitoring the quality of medical care using variance recording. 5. Developing a nursing standard that reaffirms quality patient care. Conclusions: The implementation of this clinical pathway is a positive result of National Health Insurance. It be suggested to apply clinical pathway to other health problem conditions. Besides, the discharge follow up and satisfaction of patients received clinical pathway could be continued to be other good research topics.

並列關鍵字

hernia ； clinical pathway ； cost-effect ； quality of medical care ； nursing standard