| BackgroundUrinary stones is one of the most common urological diseases, which is the highest proportion of inpatients in Department of Urology in our country. The incidence of upper urinary tract stones is the highest, which is as high as 86%. Treatment of upper urinary tract calculi occupies an important position in the Department of urology. Currently, percutaneous nephrolithotomy (PCNL) gradually replaced open surgery position as the upper urinary tract stones, kidney stones especially important surgical methods, lithotripsy and ureteroscopy (URL) and extracorporeal shock wave lithotripsy surgery (ESWL) together become the three main methods of treatment of urinary stones. Because of the onset and the number of renal calculus, renal calculus becomes the social and economic burden gradually become an important public health problem. How to reduce the cost of hospitalization in patients with these diseases, shorter hospital stays, improve health care efficiency, and ensure the success rate of surgery has become an important issue of concern in today’s treatment of kidney stones. The clinical pathway is a new medical model which was invented to solve the purpose. In 1980s, the North American began to develop and promote the clinical pathway management. Clinical pathways developed later in China. In 1990s we started to explore the Clinical pathways. It hasn’t immature, specially to be short of the Clinical pathways for the treatment of Surgery Dept. And Clinical pathway of PCNL is not yet mature. Guangdong provincial hospital of traditional Chinese start to carry out a traditional Chinese of Clinical pathway for PCNL. Through a lot of optimization, it prove that it has great helpness for the medical effect and decreasing costs.PurposeOptimizate Clinical pathway for PCNL of Guangdong provincial hospital of Traditional Chinese Medicine, and evaluate the effect of it.MedthodsThis paper uses a retrospective case study of the effect of the method of analysis. The study performed restospective study of renal calculus patients which were hospitalized in the Guangdong provincial hospital of optimization before (from January 2013 to December 2013) and after (from January,2014 to December 2014). The main out come measures were mean length of hospital stay;hospitalization costs;improvements in clinical symptom and so on. Clinical observation and recording of the table is demanded. SPSS19.0 is used for statistical analysis of the data collected.Result156 patients,80 of control group, and others of optimization group. There were no significant difference between the two groups on admission. The mean length of hospital stay was reduced from 9.85±2.44 to 8.96±1.72 days. The total hospitalization cost has reduced from 19811.79±3393.15 to 19747.45±3004.06 yuan. The antibiotic costs has reduced from 2140.68±1017.91 to 1908.99± 932.11 yuan. The Chinese crude durg costs has rised from 196.09±192.17 to 247.41±123.27 yuan. The Chinese patent medicine costs has rised from 150.05 ±274.38 to 218.57±73.50 yuan. The costs of total hospitalization and antibiotic do not have significant differences. Contrast the incidence of complications, removal time of nephrostomy tube and the situation of the return do not have significant differences.ConclusionThe research indicate that after optimization of the clinical pathway, the mean length of hospital stay have been obviously reduce. The costs of Chinese crude durgs and the Chinese patent medicine costs haved rised obviously. The costs of total hospitalization and antibiotic do not have significant differences. Contrast the incidence of complications, removal time of nephrostomy tube and the situation of the return do not have significant differences. Clinical pathway is a new medical management model, the continuous optimization and improvement are necessary in order to further guide for clinical practice. |
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