成人肾穿刺活检术临床路径的变异分析

Variation Analysis of Clinical Pathway Applied in Adult Percutaneous Renal Biopsy

目的分析成人肾穿刺活检术临床路径的变异因素,探讨临床路径实施中存在的问题并提出改进措施。方法对123例成人肾穿刺活检术患者的临床路径资料进行回顾性分析,了解其中变异发生情况并探讨其影响因素。结果本组发生变异45例,变异发生率36.6%;其中正性变异占62%,负性变异38%;与医院系统相关的变异占38%,与疾病转归相关的变异占27%,与医务人员相关的变异占18%,与患者、家属相关的变异占15%,退出2%;可控变异占58%,不可控变异占42%。影响正性变异发生的因素为年龄、是否有术前合并症;负性变异发生的影响因素为是否有术前合并症、是否二次肾穿。结论本组病例在临床路径实施过程中存在变异情况,应根据变异发生情况及其影响因素,进一步完善医院的工作制度,做好各科室协调配合;严格规定纳入、排除标准,减少与疾病转归相关的变异;改进临床路径记录单,完善对变异信息的记录。

Objective To analyze variation of clinical pathway in adult percutaneous renal biopsy and to explore existing problems and put forward improvements.Methods A retrospective study was conducted for the data of clinical pathway of 123 adult cases with percutaneous renal biopsy to obtain information about the variations and its influencing factors.Results 45 patients were with variations in the study while 78 patients without.The incidence of positive variation and negative variation were 62%（28/45） and 38%（17/45）respectively;38% of the variations were related with hospital system,27% with disease outcome,18% with medical staff,15% with demand of patient,2% with patients’ withdrawal;58% of the variations were controllable variation,42% were uncontrollable ones.The main factors affecting variations were three indicators： age,whether the second operation,and whether with preoperative complications.Conclusion Further improvement should be strengthened by hospital itself.Clinical pathway implementation should be coordinated with the department staff and with a strict inclusion,exclusion criteria.Meanwhile,the recording of variation should be improved.