Construction Ofperioperative Clinical Pathway Of Traumatic Spinal Cord Injury Patients

Objective:Through perioperative clinical pathway of traumatic spinal fractures with a spinal cordinjury patients,which is also called Project Time Frame of reasonable standard process inhospitals. standard process could order staff's work,simultaneously standardise medicalcare behavior,reduce the waste of resources,ensure medical quality. At the sametime,formulating corresponding nursing scheme can make the nursing staff to providetimely normalization nursing measures for patients in order to reduce the patientsperioperative complications and promote patients recover. The construction of the clinicalpathway provide the reference for continual medical and nursing quality improvement.Methods:1,Make clinical pathway of spine fracture with a spinal cord injury perioperative andthe care scheme draft based on Evidence-based medicine combined with clinical seniorexpert opinions and Suggestions,literature review by searching related articals in CKNI,VIP-database Spring Science,EBSCO database,medical record review by reviewing relatedinformation of patients diagnosed as traumatic spinal fractures with a spinal cord injury inorthopaedics from January2009to July2010are also used.2,According to relevant guidelines and principles,Delphi method is used through theexperts consulation,we get same agreement on accessing clinical pathway standard,discharge guideline,implementation effect evaluation index,Nursing programmes draft andperioperative clinical pathway. Finally,the standardize length of stay,preoperativepreparation and postoperative recovery time were10days,4days and6days respectivelyin this study.Practical perioperative clinical pathway of spine fracture patients with spinalcord injury patients is ascertained.3,We use prospective randomized controlled trials method to verify the clinical pathwayimplementation effect. Objects of study are patients who are diagnosed with spinal cordinjury and spinal fracture in two grade-Ⅲ generalhospitals in shanghai from June toDecember2011.Patients are randomly divided into two groups according to hospitalizationrecord number,patients with an odd number routine are in routine medical care group,witheven number in clinical pathway group. Based on a review of the cases from January2009to July2010,30%cases are randomly selected as historical control group. We comparedbasic information,length of hospital stay,preoperative days,charge and medical quality information of the three groups,patient satisfaction and health knowledge awareness arecontrasted between routine medical care group and clinical pathway group. Statisticalsoftware SPSS16.0is used for processing and analysis collected data. The data areanalyzed with methods as descriptive statistic,one-way ANOVA or non-parametric test;Chi-square test are used for comparison of constituent ratio or rate. TOPSIS method isused to evaluate the effect of the comprehensive evaluation index analysis,size of test:a=0.05.Results1,Item-time framed scientific and reasonable spine fracture with a spinal cord injuryperioperative clinical pathway and seven related care scheme are formulated by literaturereview,case history records review and the evidence-based medical.2,Through the Delphi method,The entries in expert questionaire are screen andjudged,we perfect perioperative clinical pathway standard process and related contents oftraumatic spinal fractures with a spinal cord injury and make them more scientific andfeasible.3,we use prospective randomized controlled trials method to verify that the clinicalpathway implementation effect. There is no statistical significance between clinicalpathway group and control group in length of stay,preoperative days and cost ofhospitalization through single index effect analysis. CP group compared with traditionalgroup and history group which preoperative hospital day was shorten0.39days and1.71days respectively; the length of day shorten0.22days and4.91days respectively by mean.;cost of hospital reduced4080yuan and4857yuan respectively. However,clinical pathwaygroup is better than the control group by Topsis Method.4,There was not statistically significant in terms of patient's satisfaction between theclinical pathway group and the control group in the same period,but we get statisticallysignificant items such as the nurse communication skills satisfaction, preoperative waitingtime,satisfaction to medical auxiliary department,health education satisfaction,introductionof attentions in perioperative period,pain control after surgery satisfaction and rehabilitationguidance after discharge.5,There was not statistically significant between clinical pathway and control group in thedegree of mastering health knowledge,however,there is essentially difference betweenclinical pathway and control group significant in knowledge of rehabilitation awareness,suchas importance of diet and nutrition,the importance of pressure ulcers prevention and management, urinary infection prevention methods,the importance of preoperative breathingtraining(P＜0.05).Patients in clinical pathway group get better awareness than traditionalcontrol group in deep breath and cough after surgery,relieve pain and various complicationsprevention after discharge which is statistically significant (P＜0.01)6,There is no essentially difference between clinical pathway and control group in theincidence of complications such as the bedsore, urinary tract infections, pulmonary infection,infection of incision, spinal cord injury again, constipation and abdominal distention, lowerlimb vein thrombosis.7,Variation in clinical pathway implementation was analyzed in detail. The cause ofvariation included the disease itself,complications(hypertension,diabetes),and holiday whichinfluenced patients in accordance with clinical pathway procedure.Conclusions:This study constructed the traumatic SCI perioperative clinical pathway and seven careplan based on the literature review, the medical record review and evidence-basedmedicine, while standardize the hospital stays for10days, perioperative time for4days andpostoperative time6days. We revised the clinical and seven care plan to make them morescientific, feasibility and practical by Delphi method for the two round. Through theprospective randomized controlled trial, the results indicated that the implementation of theclinical pathways reduced average4.91days than the history group and average0.22daysthan the control group in the SCI patients around the time of surgery, while averagehospital expenses decreased￥4857than the history group and￥4080than the controlgroup. The implementation of this clinical pathway guaranteed the medical service quality,and keeped it in the optimal level. Improving SCI patients perioperative satisfaction andthe degree of health knowledge master.