KISEP Original Articles 臨床耳鼻 : 第 11 卷 第 2 號 2000 J Clinical Otolaryngol 2000;11:256-260 편도및아데노이드절제술에서 Critical Pathway 의적용 변성완 윤선옥 장주애 이재연 신혜정 홍순관 Implementation of a Critical Pathway for Tonsillectomy and Adenoidectomy Sung-Wan Byun, MD, Sun Ok Yoon, MD, Ju Ae Chang, MD, Jae Yeun Lee, MD, Hye Jung Shin, MD and Soon Kwan Hong, MD Department of Otolaryngology, College of Medicine, Ewha Womans University, Seoul, Korea - ABSTRACT - Background and ObjectivesThe current health care climate demands the provision of patient care in a cost-effective manner. Critical pathway implementation has the potential to standardize treatment and improve the cost-effectiveness. The aim of this study was to evaluate whether implementation of a critical pathway for tonsillectomy and adenoidectomy would affect the time of charting and patient care and the satisfaction of patients. Materials and MethodsOne hundred seventy one patients were included in the study. The critical pathway was implemented for 146 patients while the other 25 patients were treated without implementation of the pathway. ResultsThe time of charting 70% and working 45% was reduced after implementation of critical pathway. Patient satisfaction was increased in both kindness of health care team 12% and patient care itself 12%. The variation of length of hospital stay was 20.5% 30/146. ConclusionImplementation of a critical pathway has played a significant role in decreasing the time of charting and patients care and increasing patient satisfaction. Thus critical pathway implementation is an effective method to save the time of medical care team and to increase patient satisfaction. J Clinical Otolaryngol 2000;11:256-260 KEY WORDSCritical pathway Tonsillectomy Adenoidectomy. 서 256 론
대상및방법 257
J Clinical Otolaryngol 2000;11:256-260 A B Fig. 1. A, B Critical pathway (Tonsillectomy and Adenoidectomy) for medical team. 258
Table 1. Satisfaction of patients n50 Score* before implementation of critical pathway n25 Score after implementation of critical pathway n25 p value in Mann- Whitney U test The degree of satisfaction at 8.28 9.48 p0.01 procedure The degree of kindness of medical team 8.48 9.71 p0.01 *Maximum score10 Table 2. Satisfaction of medical team n10 Working time Charting time Doctors n5 5.6* 2.6 Nurses n5 5.4 3.4 Total n10 5.5 3.0 *Numbers are relative amounts of working time and charting time assessed subjectively referenceamount before implementation of critical pathway10. Fig. 2. Variation sheet of critical pathway. 결과 Table 3. The variation of critical pathway implementation in present study n146 Hospital stay Cause Cases % 3 days 2 nights Request by patient 20 13.7% 5 days 4 nights Pain 5 3.4% Fever 3 2.1% Postoperative bleeding 1 0.7% 6 days 5 nights Pain 1 0.7% Total 30 20.5% 259
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