One-year experience with an inpatient asthma clinical pathway
One-year experience with an inpatient asthma clinical pathway
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DOI：
10.1001/archpedi.1997.02170440046008
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发表时间：
1997-07-01
影响因子：
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通讯作者：
Marcus, EK
中科院分区：
文献类型：
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作者：
KwanGett, TS;Lozano, P;Marcus, EK
目的：研究哮喘临床路径对住院治疗儿童哮喘过程和结局的影响。设计：前后研究。地点：华盛顿州西雅图一家私立非营利性学术儿童医院。患者和方法：比较哮喘临床路径第一年297例患者的342例住院病例和前一年292例类似病例的353例住院病例。需要重症监护、年龄小于2岁或患有重大慢性病的患者被排除在外。干预：哮喘因其入院人数多、涉及多个医疗保健提供者(护士、医生和呼吸治疗师)、可预测的住院过程和不同的住院时间而被选择用于临床路径的开发。该路径是一种基于共识的患者管理指南，旨在适应单个患者的护理。在实施临床路径之前，护士、主治医生、医院工作人员和呼吸治疗师都接受了使用方面的培训。每个进入该路径的患者的主要医院病历都有一个流程图，其中概述了监测和护理的日常指导方针。护理人员负责记录患者的护理与路径的差异，并将这些差异输入计算机数据库。结果：通过分析患者的电子账单记录，评估峰值流量计、类固醇、实验室研究、放射学研究和呼吸治疗的使用。对于登记在路径中的患者，通过分析方差数据库获得关于护理过程的额外数据。结果：两组患者在激素和峰值流量计的使用、平均住院时间和总费用方面无显著差异。然而，“路径组”的患者的平均实验室费用明显较低(26美元对39美元；P
Objective: To study the effects of an inpatient asthma clinical pathway on the processes and outcomes for children who were admitted to a hospital for the treatment of asthma.Design: Before-and-after study.Setting: A private nonprofit academic children's hospital in Seattle, Wash.Patients and Methods: Three hundred forty-two admissions of 297 patients in the first year of the asthma clinical pathway were compared with 353 admissions of 292 similar patients in the previous year. Patients who required intensive care, were younger than 2 years, or had a major chronic disease were excluded.Intervention: Asthma was chosen for the development of a clinical pathway because of its large number of admissions, involvement of multiple health care providers (nurses, physicians, and respiratory therapists), predictable hospital course, and variable lengths of hospital stay. The pathway was a consensus-based guideline for patient management that was intended to be adapted to the care of an individual patient. Prior to the implementation of the clinical pathway, nurses, attending physicians, house staff, and respiratory therapists were trained in its use. The main hospital chart of each patient who was admitted to the pathway had a flowchart that outlined day-to-day guidelines for monitoring and care. Nursing staff were responsible for documenting when a patient's care varied from the pathway, and these variances were entered into a computer database.Outcome Measures: Use of peak flowmeters, steroids, laboratory studies, radiological studies, and respiratory therapy was assessed by analyzing the patients' electronic billing records. For patients enrolled in the pathway, additional data on process of care were obtained by analyzing the variance database. For both groups, the total charges, length of stay, and rate of readmission to the hospital were measured by use of the billing records.Results: There were no significant differences in the use of steroids or peak flowmeters, average lengths of stay, or total charges between the 2 groups. However, patients in the ''pathway group'' had significantly lower average charges for laboratory ($26 vs $39; P