Study Of The Effect Of Clinical Nursing Pathway For Severe Traumatic Brain Injury (STBI) In The Emergent Stage

clinical pathways are clinical management tools used by multi-professional health care workers to define the best process in their organization, using the best procedures and timing, to treat patients with specific diagnoses or conditions according to evidence-based medicine (EBM). The implementation of clinical pathways is beneficial to the development of competitive strategies , medical cost and the quality of medical service . Clinical pathways were used in clinical service of many hospitals because they are scientific methods of service and management that can reduce medical cost and ensure the high quality of medical service.Clinical pathways ,originated from America ,are gradually adopted and developed in many advanced areas in the world such as France ,Britain, Australia, Japan ,Singapore, Taiwan and Hong Kang in our country .According to a great deal of foreign literature about the studies of clinical pathway, which shows that it is fundamentally ripe for implementation of clinical pathway abroad with the continual developments of nursing theory and clinical practice .Clinical pathways are widely implemented in 60% hospitals in America ,the kinds of clinical pathways are not simplebut extended from surgical to medical cases ,from emergent to chronic cases ,from hospitalization to community service ,from simple clinical management to every aspect of hospital management . They were introduced into Chinese Mainland in 1998 and attracted the attention of many scholars all over the country to explore the theory and application of clinical pathways in order to improve the quality of nursing and connect with new international theories , concepts and principle of nursing . In foreign countries, there were some reports about clinical pathway for patients of severe traumatic brain injury(STBI), such as phased-outcome clinical pathway, this pathway was refashioned into a severe TBI phased-outcome pathway rather than a day-by-day plan of care, it consists of four phases of care: (a) admission to the intensive care unit, (b) acute critical care, (c) mobility and weaning, and (d) pre-rehabilitation. Purpose of the present research is to evaluate the effect of effective rapid clinical nursing pathway in emergent stage (resuscitation in emergency room and critical care in neurosurgical department ) for severe traumatic brain injury (STBI) to provide the sequence and timing of actions necessary and reducing medical cost to achieve sustainable improvement of medical quality with optimal efficiency. The present study performed retrospective cohort study of STBI patients who were resuscitated in Emergency Room and hospitalized in Neurosurgical department of No.2 Hospital ,Ji LinUniversity before and after the implementation of clinical nursing pathway . (control group :32 STBI patients who were resuscitated in Emergency Room and after emergency treatment 30 patients hospitalized in Neurosurgical department of No.2 Hospital ,Ji Lin University from Dec 2005 to Jun 2006;intervention group :34 STBI patients who were resuscitated in Emergency Room and after emergency treatment 33 patients hospitalized at same department from Jul 2006 to Jan 2007.) Being ensured the patients in intervention group treated by the effective rapid nursing pathway ,the self-designed clinical nursing pathway of STBI was based on a lot of relevant literature ,advice of many experts and experienced doctors and nurses ,the reference of American Nursing Clinical Pathways translated by Dr yuan jian yun , great support of administrators and managers of the hospital .The patients who were in it have been recorded and evaluated by a phased-outcome clinical nursing pathway . All data were input into database Foxpro6.0 and statistically analyzed with SPSS12.0 software. Chi-squared test was done in enumeration data and t test in measurement data .The result showed that :1.There were no statistical differences of age, gender, Glasgow Coma Scale (GCS), Injury severity scale (ISS) ,medical history between two groups ,thus it can be comparable . 2.Time of resuscitation and clinical examination was significantly shorter in intervention group ( P <0.05);3.The medical cost in EmergencyRoom was higher in control group;4.The average length of stay in hospital was reducing in intervention group( P < 0.05);5.There were no significant differences of GCS on admission and Day 7th of hospitalization between two groups( P > 0.05).6.The incidence of urinary infection and pulmonary infection in intervention group was significantly lower than control group( P < 0.05=,and there were no statistical differences of the incidence of ulcers , deep thrombosis of pelvic limb, renal failure( P > 0.05)between two groups. 7.There was no statistical difference of medical cost in hospitalization between two group ( P> 0.05). Conclusion:The implementation of effective rapid clinical nursing pathway contributed to decreasing time of resuscitation, medical cost in emergency room, the average length of hospital stay and the incidence of some hospitalization complications during critical care ,which can provide optimal nursing plan of phased-outcome evaluation, save time , relieve patients'pain ,cooperate with doctors actively and achieve sustainable improvement of nursing quality. The present study of clinical pathway requires further research because it is beginning of the implementation of clinical pathway in our country .