冠状动脉搭桥术后ICU临床路径的变异分析与改进

Variations Analysis and Improvement of a Clinical Pathway in the Intensive Care Unit Management of Post Caronary Artery Bypass Grafting

目的探讨冠状动脉搭桥(CABG)术后ICU临床路径(Clinical pathway,CP)管理的变异情况及如何持续改进。方法连续观察了实施临床路径管理的择期冠脉搭桥术后在ICU监护治疗的患者100例。在临床路径表单标记每日目标完成情况,对于偏离路径的情况在变异记录单上记录并说明原因。结果按变异原因分析。发生医护相关性变异(45％)、患者相关性变异(28％)、系统相关性变异(5％);按变异种类分析,发生负性变异(20％)、正性变异(30％)、可控性变异(15％)。结论通过对冠状动脉搭桥病人术后ICU 临床路径变异情况的记录与分析,有利于医疗质量持续改进,并为科学制定临床路径提供依据。

Objectives To explore the variation factors and connnuous quality imvrovement of a clinical pathway for patients undergoing elective coronary arteryby pass grafting in the intensive care unit. Methiods Medical records were retrospectively in consecutive 100 patients admitted for selected coronary anery bypass graning after implementation of the clinical pathway. The everyday expected protocols and clinical outcome data were noted in the clinical pathway tables. When the variations were found to be dffetent from the protocols of clinical pathway, variations reasons and analysis were added to the tables. Results The associated reasons were doctors and nurses （45%）, patients （28%） and medical system （5%） according to the reasons of postoperative variations. On the other hand, the associated factors were negative variations （20%）, positive variations （30%） and the control variation facors （15%） according to the variation categories. Conclusions These results suggest that the notes and analysis of the clincal pathway variation factors for ICU patients undergoing coronary artery bypass grafting are beneficial for continuous medical quality improvement and offer the scientific evidence for developing clinical pathways.