急性脑梗死临床路径管理的改进及效果观察

The improvement of clinical pathway management in patients with acute cerebral infarction

目的观察临床路径管理的改进效果。方法收集2010-2014年收治的急性脑梗死患者660例,按居住地、发病后的就医行为、入院途径、院前时间等分类统计找出院内延误的因素,对以往流程不畅的重点环节予以修改完善,将单病种质量控制指标内容纳入流程中,分析优化前后患者入院到接受治疗的时间、主要质控指标达标率。结果优化流程后入院至接受治疗时间平均为(75.00±4.12)min,与优化前比较差异有统计学意义(P<0.01);优化后在60~90min内完成治疗患者的百分比大于优化前,差异有统计学意义(P<0.01);优化流程后神经功能缺损评价率、抗栓药物使用率、吞咽困难评价率、降脂药物使用率、深静脉血栓预防率、出院后抗栓药物使用率等单病种质控指标完成率明显提高,差异具有统计学意义(P<0.01)。结论优化临床路径管理,使流程更合理顺畅,医护人员执行力提高,患者从入院到接受治疗时间大大缩短,各质控指标完成率明显提高,达到提高医疗质量的目的。

Objective To explore the improvement effect of clinical pathway management in patients with acute cerebral infarction. Methods By collecting 2010- 2014 660 patients with acute cerebral infarction,according to the place of residence,after the onset of the medical behavior,way of admission,pre-hospital time classified statistics to find out factors of hospital delay,modified the important link in the past poor flow,and the single disease quality control index was included in the process. Admission to the time of treatment,the main quality control index compliance rate between before and after optimizationResults After optimizing,the process average time for( 75. 00 ± 4. 12) min,as compared with that before optimization had statistical significance( P < 0. 01). Optimization within 60 ~ 90 minutes to complete the percentage was greater than that before optimization,the difference was statistically significant( P < 0. 01). Process optimization evaluation of neural function defect rate,antithrombotic drug use rate,difficulty swallowing evaluation rate,lipid-lowering drug usage,deep venous thrombosis prevention rate,discharge of antithrombotic drugs use rate of single disease quality control index of the completion rate increased significantly( P < 0. 01). Conclusion Optimizing clinical pathway management,make the process more reasonable and smoothly and improve the executive force of medical personnel,and patients from the hospital to accept the treatment time is shortened,the quality indicators for the completion rate increases significantly to improve medical quality.