Study On Formatiom And Effect Evaluation Of Clinical Pathway Management Of Ureteral Calculi Inpatients In A Teriary Hospital

Background:Clinical pathway is a scientific and time sequence of patients care plan that carried out by medical treatment, care and related professional personnel according to certain diseases or operations. Through the lateral control of some patients’medical process which involves medical treatment, nursing, medical technology, logistic support and so on. So as to achieve the goal of taking the patients as the center and key process link integration of cross-section and cross-individual. The emphasis is put on improving the effectiveness of the core process during medical and nursing section in hospital business, therefore, to improve the overall efficiency of the hospital. As a new quality management mode, clinical pathway has attracted the attention of public health administrative department in China and hospital administrators because of its great contribution in improving medical quality, ensuring medical safety and reducing medical cost. There are variety methods of clinical treatment of ureteral calculi. In traditional clinical treatment, different attending doctors performed clinical work according to their "pathway" and medical knowledge and had different results. Quality can be hardly improved because no unified standards in peer review and differences exist between young physicians and senior physicians. In the present, urolithiasis rank first in urology surgery, especially ureteral calculi. People with ureteral calculi are more suitable for the implement of clinical path management because of more hospitalized patients, long time of hospitalization, endoscopic minimally invasive treatment for most patients, smaller differences between patients. Based on the above background, there is urgent and necessary to discuss and formulate clinical pathway for ureteral calculi. Also, it is of great importance to guide the physician’s clinical treatment and reduce the burden of patients.Objectives:This research put clinical pathway management into effect on the ureteral calculi of urology surgery department in the Second Hospital of Shandong University, to understand the formulation and implementation of process of clinical pathway; to analyze the variation and exit situation of clinical pathway and to discuss the quality of clinical pathway’s continuous improvement. Then, take the evaluative research from the aspect of average length of stay, medical cost and satisfaction of patients. Proposals to the problems in the research should be offered at last.Methods:The reference documents of clinical pathway published by authority were collected, read and analyzed through literature review method in order to understand their essence and demands. It is based on reviewing all chapters of Urinary Surgery, and consulting electrical journals about ureteral calculi.1272urology calculi patients in the Second Hospital of Shandong University between March2003and July2007acquired in information center database were analyzed retrospectively. Determine the clinical pathway of the implementation of the disease which was as the basis of the clinical pathway management of ureteral calculi. The effect of67patients managed by ureteroscopy holmium laser gravel the clinical pathway management was evaluated by case-control study.Results:1. Through the retrospective analysis the information of urology calculi patients in the center database in March2003to July2012, ureteral calculi has determined as urology clinical pathway of the implementation of the disease. Ureteral clinical pathway form has formulated according to the clinical pathway of ideas, methods and principles.2. There were1272cases patients with calculi disease in the Second Hospital of Shandong University in the2003.3-2012.7periods, accounting for12.91%of the total inpatients. The male for898cases, female for374cases, the male to female ratio is2.4:1. The age of onset is14-83years old.1272cases of calculus patients,865patients with ureteral calculi, accounting for68.03%. Calculi patients’onset ages have central tendency, age from33to53years old takes the majority.3. After the implementation of the clinical pathway management for the ureteral calculi patients, the average length of stay in hospital has shortened2.47days and waiting days has shortened1.6days compared to the control group. Test cost has been reduced by about220Yuan; radiation cost has been reduced by about182Yuan, expenses for medicine has reduced more significantly, for1021Yuan. The cost of hospital has reduced2437Yuan totally. The comparisons of two groups were significantly different. But the difference between cost of anesthesia and operation are not obvious. There was no significant difference across two groups. The satisfaction of patients in clinical pathway management has increased by4%.Conclusions and Suggestions:Clinical pathway management of ureteral calculi can not only guide the medical behavior of patients, but also regulate the medical behavior. The clinical pathway management of ureteral calculi can effectively shorten the hospitalization time and decrease medical cost, improve medical care quality, strengthen the ability of doctor-patient communication and improve the satisfaction of patients. The result of clinical pathway should be regularly analysis and feedback, so as to promote its continuous improvement and development. At the same time, perfecting the corresponding laws and regulations, improve the information management system can’t be ignored, starting from the practice and exploring suitable measures for performing clinical pathway according to Chinese reality and characteristic and promoting the development of corresponding health economic policy.