Development and Clinical Application of Critical Pathways for Vaginal Delivery and Cesarean Section

Park, Yong Won; Bai, Sang Wook; Jung, Young Nae; Lee, Hae Woo; Kim, Young Ran; Hong, Sun Bok; Park, Heun Ju; Tark, Kwan Chul

Journal of Korean Society Quality Assurance Health Care 2000;7(1): 32.
Published online May 30, 2000.

정상산모의 질식분만 및 제왕절개술에 대한 표준진료지침서의 개발과 임상 적용

박용원¹, 배상욱¹, 정영내¹, 이혜우², 김영란², 홍순복², 박현주³, 탁관철³

¹연세대학교 의과대학 산부인과학 교실
²연세의료원 간호부
³연세의료원 적정진료관리실

Development and Clinical Application of Critical Pathways for Vaginal Delivery and Cesarean Section

Yong Won Park¹, Sang Wook Bai¹, Young Nae Jung¹, Hae Woo Lee², Young Ran Kim², Sun Bok Hong², Heun Ju Park³, Kwan Chul Tark³

¹Department of Obstetrics and Gynecology, College of Medicine, Yonsei University
²Department of Nursing, Yonsei University Hospital
³Department of Quality Improvement, Yonsei University Hospital

Abstract

Background
Critical pathway is an optional sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to minimize delays and resource utilization, and to maximize quality of care; abbreviated versions of case management plans that show critical outcome and key incidents that occur in a predictable and timely fashion to achieve an appropriate length of stay. This study is to develop a critical pathway for vaginal delivery and cesarean section to assess the degree of contentment of the patients and medical personnel and to implement clinical application to see how we could meet the need to guide patients to achieve continuum of care. Method : Critical pathways were developed for normal vaginal delivery and casarean section. LOS(length of stay) target for vaginal delivery was 1 day after delivery & 5 days after C-section. It was distributed to the mother at the OPD and explained thoroughly. It was applied when patients got into the Labor & Delivery Floor. We applied total of 42 patients (30 normal deliveries & 12 C-sections) from February to March, 2000. We performed patient satisfaction survey to all 42 patients, 24 nurses, and 7 residents for internal customer satisfaction.
Results
Twenty six patients out of 42 responded to the survey. Twenty one patients out of 26 answered satisfactory. Eighty four percent of 21 respondents replied Critical pathway worked very well. Treatment column got the most compliance. Eleven out of 31 employees thought critical pathway is very helpful for the patient care. Eighteen people didn't see any difference. In their opinion, treatment got the least compliance, which is the contrary to patients opinion. Fifty eight percent of respondents thought that critical pathway can expedite early discharge.
Conclusion
Patient satisfaction was higher than we expected but we still need to revise the form. It is recommended to analyze the cost and variance check in the future.

Key words Critical pathway;Casarean section;Vaginal delivery;