Variance Analysis In Clinical Nursing Pathways For Total Hip Replacement

Objective:To analyze variance factors of Clinical Nursing Pathways(CNP)for Total Hip Replacement(THR).Researches on problems in the implementation of CNP and provides some measurement to improve quality.Methods:This study applied history retrospective analysis.Its material came from a provincial hospital which possessed the Hospital Information System(HIS)and implemented CNP for THR relatively early and performed well.It was collected the network data and case records of the patients who had received CNP for THR during Jan 2002-Dec 2005.The cases were divided into variance and non-variance groups,based on the definition of variance in this study.Analysis of data in this study encompassed of statistical description which applied rate and ratio and statistical inference which using univariate statistical analysis and logistic regression. Through data statistics,main affecting factors of variance were sifted.This study provided some specific measurements for promoting nursing Continuous Quality Improvement(CQI),Based on the results of the statistical analysis.Results:1.In 149 cases,non-variance cases accounted for 49.66%(74/149),variance cases occupied50.34%(75/149).Through the statistical analysis of the causes of variances,it was found that the incidence of variance categories in present CNP which ranged from high to low (hospital system24.16%(36/149)＞disease progress18.12%(27/149)＞patients'requirements5.37%(8/149)＞practitioners1.34%(2/149)and withdraw cases 1.34% (2/149)〕.The incidence of the controllable variances were higher〔25.50%(38/149)〕than the uncontrollable,according to the manageability of variance.The incidence of the negative variances was higher〔48.32%(72/149)〕than the positives,according to the nature of variances.2.The logistic regressive analysis demonstrated that there were five factors including preoperative Length Of Stay(LOS),postoperative LOS,types of operation,the quantity of operation and postoperative complications affected on producing variance,among them, preoperative LOS had the greatest effect(standard partial regressive coefficient=0.955).Conclusion:1.The incidence of every types of the uncontrollable variances was low than 20%.It explained that the present CNP for THR could cover most of cases and it was reasonable.2.The chief problems lying on performance institution,requirement of other faculty's collaboration in implementing CNP,the occurrence of variance relating to disease progress which resulted from lack of strict selection and exclusion criteria and the imperfect of record in variance information. 3.Improved measurements:designing variance recording note and it's coding note;improving existing CNP records;formulating selection and exclusion criteria about CNP for THR(single side).The research established on the theory of hospital CQI and the recent condition of comprehensive implement of CNP domestic and abroad.It selected THR cases which applied CNP relatively early and more as objects.In this study,CNP data was accumulated,which lay basis on promoting performance.At the meantime,it provided reference for formulating measurements of nursing management.The purpose of promoting CQI and establishing intact CNP was reached through above steps.