| 제목 |
Assessment of the Implementation of Critical Pathway in Stroke Patients: A 10-years follow up study |
| 소속 |
Gyeongsang National University School of Medicine and Gyeongsang National University hospital, Department of Rehabilitation Medicine1 |
| 저자 |
Dahye Park1*, Hyeong Seop Kim1, Chang Han Lee1, Eun Shin Lee1, Chul Ho Yoon1, Heesuk Shin1, Min-Kyun Oh1† |
Abstract
Objective
To evaluate the effects of the implementation of Critical Pathway (CP) in stroke patients for 10 years.
Methods
Data were collected from 960 patients who were diagnosed with stroke at the university hospital emergency room, who were transferred to the rehabilitation center after the acute phase and discharged after undergoing comprehensive rehabilitation. Based on data collected over a period of 10 years, changes in demographic and stroke characteristics, medical complications and functional status, and length of stay (LOS) were observed before and after CP implementation. As evaluation tools of functional status, the Modified Rankin Scale (mRS), the Korean Version of the Modified Barthel Index (K-MBI), and the Korean Mini-Mental State Examination (K-MMSE) were included.
Results
There was no significant difference in demographic and stroke characteristics between before and after CP implementation. For those with pre-existing medical conditions, there was no significant difference between before and after CP implementation, except for a significant decrease in cardiac arrhythmia (p=0.008) and dyslipidemia (p=0.001). The majority of complications was significantly decreased after implementation of CP (Table 1). Except for hemorrhagic stroke patients, Brunnstrom stage of ischemic and total stroke patients after CP implementation was statistically significantly increased in the upper proximal, upper distal and lower extremity and significantly higher scores for K-MMSE at transfer to rehabilitation center (Table 2). The LOS of total hospitalization and rehabilitation center hospitalizations was statistically significantly reduced in ischemic and total stroke patients (Table 3).
Conclusion
The implementation of CP allows better application of evidence and guideline-based key interventions and help to provide early, comprehensive, organized and more specialized care to stroke patients. Despite limited evidence, CP is still recommended as a means of promoting best practice in hospital care for stroke patients. Future research on the effects of the implementation of CP in multiple institutions is needed. |
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Comparison of the number of stroke patients with medical complications before and after CP implementation
Comparison of functional states at transfer to rehabilitation center and discharge before and after CP implementation
Comparison of length of stay (LOS) before and after CP implementation
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