全膝關節置換手術緊要路徑之建立與評估

The Development and Evaluation of the Critical Pathway of Total Knee Joint Replacement

邱艷芬(Yann-Fen Chao) ； 吳巧雲(Chaio-Yun Wu) ； 黃俊雄(Chun-Hsiung Huang)

《慈濟醫學雜誌》 10卷4期 (1998/12) Pp. 311-325

https://doi.org/10.6440/TZUCMJ.199812.0311

摘要

本研究應用作業研究中之要徑法建立某醫學中心全膝關節置換術臨床路徑中的緊要路徑，資料之收集包括病歷回溯、臨床觀察、與專家判定法。所得之臨床緊要路徑為：(1)等待手術天數、(2)等會診復健科、(3)等復健科來診、(4)至復健科走路訓練、與(5)在病房走路訓練至下床活動判定滿意等。醫師別在處置緊要路徑工作項目有差異，病人的基本狀況則否。依緊要路徑估計，實行緊要路徑可縮短病患的留院天數達26%；實地實施緊要路徑管制三個月，住院天數由20.2天降至14.4天，縮短留院天數達28.7%。本研究建議各醫院以要徑法發展自己之全膝關節置換術緊要臨床路徑，以此緊要路徑監測、控制病患住院日數；並於每年以現況再評估臨床緊要路徑一次，以達永續品管提升之效果。

關鍵字

全膝關節置換術 ； 臨床路徑 ； 緊要路徑

並列摘要

The purpose of the study was to establish the critical clinical pathway of total knee arthroplasty (TKA) for cost effect management. We reviewed the medical charts, conducted clinical observations and consulted with orthopedic specialists (MDs) in one medical center to develop the TKA clinical pathway map. We applied the “Critical Path Method” (CPM) to determine the critical pathway. The jobs on the critical pathway was: admission → waiting for surgery → TKA surgery → requesting rehabilitation evaluation → waiting for rehab ilitation, doctor’evaluation → waiting for walk training → obtaining satisfactory activity level → discharge.
The average length of hospital stay (LOS) for a patient to complete the critical pathway for TKA (CPTKA) was 15 days. A table integrating the critical jobs of the CPTKA was developed and applied in the clinic to control the length of stay for TKA surgery patient for 3 months. A reduction of LOS from 20.2 days to 14.4 days was achieved. Based on the CPTKA, a reasonable cost for this procedure was established. The CPTKA is also expected to serve as a guideline for continuous quality improvement and cost control of TKA procedures in the clinical practice.
We suggest that each hospital apply CPM to develop CPTKA and use the developed CPTKA to monitor and control the LOS. We also suggest that the CPTKA be revised yearly. By this doing, a continuous improvement in quality and cost control will be obtained.

並列關鍵字

Total knee arthroplasty ； critical pathway ； clinical pathway