Bone marrow transplantation, a promising therapeutic option for marrow disorders, has till several problems such as complex and time-consuming schedule, high cost, need for aseptic management, and high incidence of complications. A systemic management of the process could reduce the duration of admission and complications, and enhance the quality of medical services as well as cost effectiveness. Therefore, the purpose of this study was to develop a critical pathway for patients undergoing bone marrow transplantation, which aims to standardize and systematize the patient care in bone marrow transplantation.
The first step of developing the critical pathway was to select the disease/treatment modality, which was bone marrow transplantation in this study. In the second step, a development team consisted of eight experts in bone marrow transplantation was organized. In the third step, the service content and the implementation period for the bone marrow transplantation was decided by reviewing medical records. In the forth step, a preliminary critical pathway was made through verification of expert group on content validity. In the fifth step, the clinical appropriateness of the preliminary critical pathway was validated by applying it to seven patients undergoing bone marrow transplantation. In the sixth step, the final critical pathway was developed.
Through the process the following results were obtained.
1. Eight categories of medical services, i.e. monitoring/assessment, treatment/care, medication, activity/safety, diet/nutrition, test, consult, education were set to vertical axis, and the hospital stay from hospital admission to the 7th day after bone marrow transplantation to the horizontal axis.
2. The mean hospital stay (from hospital admission to the 7th da after BMT) of 53 patients whose medical records were reviewed was 22.7 days, and the overall hospital stay (from hospital admission to discharge) was 45 days.
3. Among 164 questionnaires on medical service contents in 8 categories, 151 showed expert’s agreement over 88% and were selected to analyze. Thirteen questionnaires were modified because showed expert’s agreement below 75%.
4. A clinical validity test was done in eight patients. during the process, one patient was deleted because he was out of the investigator set criteria. Finally seven patients were verified using a preliminary critical pathway. The mean hospital stay of them was 21 days. Nineteen items showed differences between preliminary critical pathway and the real medical activities. Then of those nineteen items were modified of supplemented, six were deleted, and three were added to make the final critical pathway.
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