Development and Testing of Clinical Pathway for Ischemic Stroke Patients

• Main Authors: Chin-Ching Li, 酈欽菁
• Other Authors: Shiow-Luan Tsay
• Format: Others
• Language: zh-TW
• Published: 2001
• Online Access: http://ndltd.ncl.edu.tw/handle/11948875329328995471

碩士 === 國立台北護理學院 === 護理研究所 === 89 === The purpose of this study is to develop a clinical pathway for ischemic patients and to test the effectiveness of the pathway to length of stay (LOS), functional status, medical cost, patient satisfaction, staff satisfaction, and record the clinical variation. This research was a two-stage process. The first stage was to develop a clinical pathway for ischemic stroke patients. Retrospective chart review method was used. The second stage was to test the effectiveness of the isehemic stroke pathway. The study is a quasi-experimental design. Subjects include ischemic stroke patients, medical and nursing staffs. The study was carried out in a neurological ward of a medical center in the Northern Taiwan. Data were collected from the control group of 50 patients first, then followed with a matched stroke severity of experimental group of 50 patients. Data collection for the first stage was from September 2000 to October 2000. The second stage of data collection was taken between March 2001 to May 2001. The research instruments include Patient’s Essential Data List, The National Institute of Health Stroke Scale (NIHSS), Barthel Index, Clinical Pathway Variance Record List, Patient Satisfaction with Nursing Care Questionnaire, and Stroke Knowledge Measurement for Patients. McCloskey/ Mueller Job Satisfaction was used for medical staff for testing and comparison. Control group received unit routine care. Experimental group received specific care as indicated within ischemic stroke clinical pathway. SPSS10.0 software was used for coding and datd analysis. Statistic methods included mean, standard deviation, percentile, independent sample t-test, and ANCOVA. The result shows that clinical pathway can effectively shorten LOS for ischemic stroke patients. Mean of LOS was 17.5 days for the control group, and 8.9 days for the experimental group. Utilization of the pathway decreased medical cost significantly, and reduced $27919.56 in NT per person. There was no significant difference on functional status. However there was a significant difference exist when the effect of NIHSS was under controlled. The pathway also improved the stroke knowledge and satisfaction of patients and families. Additionally, the pathway promoted job satisfaction of medical and nursing staffs. In conclusion, implementation of the clinical pathway for stroke patients, it reduced 7.57 days of hospital stay, and saved $26344.11 in NT. Excluding outlier of longer LOS patients (≧30 days), results indicated that the pathway could reduce cost up to 39.94%, improve functional status, knowledge and care satisfaction of patients and families. Furthermore, the pathway also promoted job satisfaction of medical and nursing staffs.