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Journal of Korean Society Quality Assurance Health Care 2003;10(2): 176.
Published online December 30, 2003.
위절제술 환자의 표준진료지침 개발 및 적용 효과
김은희1, 김철규1, 이순교1, 김순덕2, 이혜옥2, 권정순2, 이경미2, 이민미2, 심순미2, 유용만3, 신종식3, 강은희4, 이상일1, 김병식5, 오성태5, 육정환5, 박수길1
1서울아산병원 CPI팀
2서울아산병원 간호부
3서울아산병원 의료정보팀
4서울아산병원 영양팀
5울산의대 외과
Development of a Clinical Pathway for Gastrectomy and Effect of Its Implementation in One Tertiary Hospital
Eun-Hee Kim1, Chul-Gyu Kim1, Sun-Gyo Lee1, Soon-Duck Kim2, Hae-Ok Lee2, Jeong-Soon Kwon2, Kyeong-Mi Lee2, Min-Mi Lee2, Soon-Mi Sim2, Yong-Man Lyu3, Jong-Sik Sin3, Eun-Hee Kang4, Sang-Il Lee1, Byung-Sik Kim5, Sung-Tae Oh5, Jeong-Hwan Yook5, Su-Kil Park1
1Clinical Performance Improvement Team, Asan Medical Center
2Department of Nursing, Asan Medical Center
3Department of Information Management, Asan Medical Center
4Department of Dietary and Nutrition, Asan Medical Center
5General Surgery, College of Medicine, University of Ulsan
Abstract
Background
Gastric cancer is the most common malignant tumor in Korea. Surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for reducing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients.
Methods
The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and the unplanned readmission rate between the pre-pathway group (n=67) and the post-pathway group (n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway.
Results
The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days (p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was not statistically significant (p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group and 0% in the post-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korean hospital settings.
Key words Clinical pathway;Gastrectomy;


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