临床路径管理在胆总管结石日间手术患者中的应用效果分析

Effectiveness analysis on clinical pathway of common bile duct stones day surgery

目的分析胆总管结石日间手术临床路径的应用效果,为推广日间手术临床路径管理提供有益借鉴。方法采集2016年1月至2017年12月杭州市某三级甲等医院576例胆总管结石患者资料,分析比较日间路径组、日间普通组、普通病房组患者的一般情况、住院费用、住院时间以及诊疗质量情况。结果实施胆总管结石日间手术临床路径后,患者平均住院总费用、药品费用、药品占比、耗材费用、检查费用、治疗费用及护理费用均有所下降(P<0.01),平均住院日缩短(P<0.01),院内感染率降低(P<0.05),出院转归、手术后并发症、31日内非计划再入院和非计划再次手术方面无明显变化(P>0.05)。结论实施胆总管结石日间手术临床路径对减轻患者经济负担、控制药品比率、提高医疗服务效率、降低医疗风险有明显效果。应进一步加强医院关键环节管理,并延伸日间手术临床路径服务链,推进"医院手术+社区照护"的日间手术临床路径新模式。

Objective To analyze the effects of clinical pathway of day surgery for common bile duct stones, and provide useful lessons for promoting the clinical pathway of day surgery.Methods Data of 576 patients with common bile duct stones from a tertiary hospital in Hangzhou from January 2016 to December 2017 were collected, and general conditions, hospitalization expenses, hospitalization time, and medical quality were compared and analyzed among the daytime path group, the daytime common group, and the common ward group.Results After the clinical pathway of day surgery for common bile duct stones was achieved, the per capita hospitalization costs, drug costs, drug proportion, consumables costs, examination costs, treatment costs and nursing expenses reduced(P<0.01), and the average length of stay shortened(P< 0.01), without significant change in discharge outcome, postoperative complications, unplanned re-admission within 31 days, and unplanned reoperation(P>0.05).Conclusion The clinical pathway of day surgery for common bile duct stones can reduce patient burden, control drug ratio, improve medical service efficiency, and reduce medical risks. The key link management should be strengthened, and the service chain extended to promote 'hospital surgery & community care' clinical pathway of day surgery.