-Abstract-
Background : A critical path defines an optimal sequencing and timing of interventions
by physicians, nurses, and other staff for a particular diagnosis or procedure, designed
to beffer utilize resources, maximize quality of care, and minimize delays. It can be
thought of as a visualization of the patient care process.
In this study, a review of appendectomy patient records was undertaken to identify a
critical path for the management of this treatment.
Methods : For this study, records of patients under 15 or over 65 years of age were
excluded ; cases where the patient was pregnant, or where complications developed were
also excluded. The remaining 21 cases were divided into two categories according to the
indication for appendectomy : for acute appendicitis, and for perforated appendix or
drainage of periappendical abscess. The time frame for the review was from patient
examination immediately prior to operation,through discharge.
The study team was composed of a surgon, research head nurse, education head
nurse, surgical part head nurse, and medical recorder. Following their review of the 21
charts, the team determined an appropriate progression and schedule for an
appendectomy.
Result : Through the chart and literatute review, the following aspects of the care
process were identified as typical and tracked: monitoring/assessment, treatment,
lines/drains, medication, activity, diet, tests and patient education.
Conclusion : From this study, the design team determined two separate critical paths :
one for appendecotomy only, and one for appendectomy plus drainage. Next, these paths
must be validated and fine-tuned through clinical implementation.
In addition, a comparison of our design with the critical paths determined at other
hospitals would be extremely valuable for advancing research in this area.
Lastly, the critical path approach to improving patient care and maximizing hospital
resources should be applied to other procedures.
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