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KMID : 0978820050080020066
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Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons
2005 Volume.8 No. 2 p.66 ~ p.71
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Development and Implementation of Critical Pathway for Patients Undergoing Laparoscopic Cholecystectomy
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장연수/Chang YS
이석환/이상목/홍성화/Lee SH/Lee SM/Hong SW
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Abstract
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Purpose: A critical pathway (CP) defines the optimal care process, sequencing and timing of intervention by multidisciplinary health care teams for a particular diagnosis and procedure. It plays an important role as a cost-effective health care delivery system and a tool for quality control of medical services by means of standardizing medical practices. The aim of this study is to investigate the satisfaction of patients and medical staff after implementation of a critical pathway for laparoscopic cholecystectomy and its cost effectiveness.
Methods: A critical pathway for laparoscopic cholecystectomy was implemented in July of 2004. Twenty-two patients who underwent elective laparoscopic cholecystectomy were included in the CP group between July 2004 and January 2005. The pre-CP group included 25 patients who underwent the same procedure from January 2004. The patients’ characteristics, postoperative clinical courses, medical costs and satisfaction of patients and medical staff members were compared between two groups.
Results: There was no difference in the mean age, gender, and diagnosis between the two groups. Eleven variances occurred in seven (31.8%) patients. The mean length of hospital stay decreased significantly after implementation of CP (3.6 to 3.0 days, p＜0.05). There was no difference in the postoperative morbidity and number of hospital visits. The total medical cost showed no difference between the two groups. However, the cost for treatment and examination was significantly reduced in the CP group (p＜0.05). The patients’ satisfaction was significantly improved after the implementation of CP (p＜0.05) and medical staff members were highly satisfied with the usefulness of the critical pathway.
Conclusion: The critical pathway for the laparoscopic cholecystectomy is a useful care delivery system, which decreases hospitalization and medical costs by means of standardization of medical practices while maintaining the quality of care. Also it can highly improve the satisfaction of patients and medical staff members.
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