The Implementation And Evaluation On Critical Pathway In Appendectomy For Acute Appendicitis In A General Hospital

Objective: To implement of critical pathway and to evaluate the effectiveness ofcritical pathway in appendectomy for acute appendicitis in a general hospital. Andanalyze the average hospitalization expenses, the change of patients’ satisfaction aboutbefore and after the critical pathway appendicitis surgery, to provided a reference for theimplementation and promotion of the critical pathway on the standardization inappendectomy for acute appendicitis.Methods: This research adopts the research methods of historical comparison，and all objects are from the general surgery of one hospital of Dalian. The patientswhose first diagnosis was acute appendicitis and implemented of appendectomy surgeryduring September2012~December2013were adopted into Critical Pathway group(experimental group), in the same time, collection general surgery admitted during May2011~August2012in line with the cases of appendectomy the standard of the patientswere adopted into conventional group (control group).Critical Pathway established bythe Department of the Steering Group and Implementation Group, according to thecharacteristics and the methods and content for the treatment of diseases, extensiveinformation and literature review, the full evidence-based, expert evaluation to developclinical nursing surgery table standard path, to develop the most appropriatestandardization, the process of clinical nursing and clinical care path table patientversion of the path. Standard-setting days, inspection, treatment, care and so on. Theexperimental group using the clinical path of patients in the control group of patientsusing conventional method, and patient satisfaction surveys. To analysis results throughthe study of statistical methods statistical. SPSS16.0all data are used for statisticalanalysis software package, using t test measurement data; χ2test for the use of countdata.Results: The proportion of the comparison for the two groups of patients in age, gender, and the status of medical insurance have no statistical significance（P>0.05）,comparable. On the preoperative waiting time, before surgery the experimental grouppatients waiting time，as well as the recovered time and total time is no change incompare with the control group (P>0.05）. In terms of the cost comparison of patientgroups, the total hospitalization costs of the experimental group(RMB6970.16) patientsis not more than the control group(RMB7030.28),（P>0.05）. Two groups of patientshave no statistical differences in the aspect of medical expenses. Further results showthat the two groups of patients with only the difference between health care costs （P=0.00）, all the others besides drugs cost（P>0.05）,other cost(Oxygen treatment cost,anesthesia cost, disposal costs)（P>0.05）,Daily room cost（P>0.05）and test cost（P>0.05）are not increased. What’s more, patients’ satisfaction of experimental group isbetter than the control group significantly （P <0.05）.Conclusion: In this study, the critical pathways management in deed control theaverage hospitalization expenses, Patients with an average of such confinement,preoperative and postoperative such confinement has no obvious change; Theimplementation of critical pathways management in patients with the average expensesfor medicine, treatment costs, tests and other (oxygen, anesthesia, disposal costs), dailyroom costs, examination costs increased significantly, operation cost, nursing cost isalso good. At last, the critical pathways management obviously improve the patients’satisfaction, which indicates that critical pathway management mode in the cost ofsingle diseases management can improve the patients’ satisfaction, and controlhospitalization expenses, the tests for surgical resection of appendicitis standard criticalpathways and provides important reference basis, it is advantageous to the continuousoptimization of clinical pathway in our exploration.