This study was conducted to develop a critical pathway which can satisfy the needs of patients and promote the satisfaction of medical professional care for patients who have laminectomy, diskectomy, posterior lumbar interbody fusion and pedicle screw fixation. In order to identify the overall service contents required by these patients and to draw up a preliminary critical pathway, 52 cases of medical records of patients who had lumbar operation between March and December, 1999 were analyzed. For this study five critical pathways which are currently being used in hospital were analyzed, and developed a conceptual framework. An expert validity test was done for patients with spinal disc surgery between February 1 and March, 2000 to certify the capability of use actually. After these processes, the final critical pathway was developed.
The results of this study are summarized as follows;
1. The vertical axis of the critical pathway includes the following seven items, consultation, medication, treatments, nutrition, activity, assessments, and education discharge planning ; and the horizontal axis includes the time from the start of hospitalization to discharges.
2. According to the results of medical records analyzed in order to develop the preliminary clinical, average of treatment period of laminectomy, diskectomy(1st group) was 7.1 days and that of posterior lumbar interbody fusion and pedicle screw fixation was 14.4 days. Analysis of the service contents showed that the horizontal axis of the preliminary critical pathway was set from hospitalization to the 7th(lst group) or 14th(2nd group) post operation day and the vertical axis included 8 items which had to occur on the basis of time frame.
3. As a result of the experts validity for each item of preliminary critical pathway, there was over 86% agreement for 93 out of 103, less than 86% for 10 items, which were then deleted, modified and added.
4. A clinical validity test was done for 15 patients who had spinal disc surgery between February 1 and March 31, 2000. The prescription of discharge wasn´t out of basis, but delayed 1-2 days. Because they had a disturbed feeling about discharge.
5. According to the results of the clinical validity test, the following items were added in the final critical pathway IV therapy, pain control and muscle relaxation on the start of hospitalization ; and added sulfase on the third post operation when patients need.
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