摘要
目的 通过对临床路径管理模式的学习,分析输尿管结石实施临床路径的变异原因.方法 按照卫生部单病种临床路径管理模式对126例输尿管结石实施临床路径,手术方式为输尿管硬镜弹道碎石术.路径模式为：住院第1～2天为术前各项准备工作日,第3天为手术日,第4～5天为术后治疗日,第6～7天为安排出院日.结果 输尿管结石临床路径实施过程中的变异因素主要有三类：系统变异、医务人员变异及患者因素变异.三种变异因素可相互交错存在.主要变异因素为患者解剖结构异常导致的系统变异,这种变异因素具有不可预知性,成为决定路径能否顺利实施的关键.其次为患者因素变异,表现为患者对临床路径治疗模式的不理解以及结石合并其他疾病等.最后为医务人员因素,包括向患者解释临床路径的态度及方式、手术操作熟练程度等.结论 对系统变异、医务人员变异及患者因素变异提出相应的改进措施,为将来更好地实施临床路径提供经验.
Objectives To study the clinical pathway management mode, and analyze the variation reason of the clinical pathway implementation of ureteral calculus. Methods According to the single disease clinical pathway management mode announced by the Ministry of Health, we implemented clinical pathway on 126 cases of patients with ureteral calculus, and the operation method was ureter mirror ballistic lithotripsy. The clinical pathway was designed as ~following, the 1st to 2nd days after hospitalization were used for the preparation before surgery, the operation was performed in the 3rd day, the 4th to 5th days were treatment days and the 6th to 7th days were used to arrange discharge. Results The variance factors of clinical pathway implementation Of ureteral calculus process mainly had three categories, system variability, medical staff and patients factor variation, and three factors may be interleaved exist. The most important factor was structural abnormalities led by the anatomy variation of the patients, this variation was unpredictability and became the key to the smooth implementation of the pathway. The second important factor was patients factors variation, such as the lack of understanding of the patients to the clinical pathway treatment model and stone complicated with other diseases. The final factor was the medical staff, including the attitudes and methods of operation they explained to the patients, the proficiency of the operation. Conclusions We should put forward the corresponding measures to improve variation factors such as system variability, medical staff and patients factors, thus provide experience for the better implementation of clinical pathway in the future.
出处
《中国病案》
2014年第2期77-78,共2页
Chinese Medical Record
关键词
输尿管结石
临床路径
变异
Ureteral calculus
Clinical pathway
Variation
