| Background:Lumbar disc disease is one of the most common disease of bone. Is mainly due to lumbar disc prolapse is located in the waist4-5, waist5sacral1lumbar nucleus pulposus annulus fibrosus and cartilage plate (more than95%of the total), a degenerative changes, due to external forces, especially the influence of the powerful external forces, cause the bulgin, hernia of intervertebral disc nucleus pulposus tissue in the rear or spinal canal, subjected to spinal nerve root compression, thus a series of clinical symptoms. Age of onset of lumbar disc prolapse crowd of25to50years old, accounts for about three-quarters of the total number of disease. And the incidence of the disease in various industries in the crowd are generally higher. Clinical pathway is developed by industry quality management system, originating in the1950s, in the1980s after get long-term development. In medical system, mainly for the application of one or one kind of disease to establish evidence-based medicine and guidelines as guidance, to promote the standardization of the disease treatment, to avoid the same kind of disease in different countries, different hospitals, different treatment group or physicians appeared between different treatments of a set of standardized procedure for the treatment of disease. The clinical data of clinical pathway can provide improving the prognosis of diseases, and provide the basis for lowering the cost of the treatment of diseases. Because the objective cause clinical pathway research in our country is still at an early stage. The study of clinical pathway for theoretical study and clinical practice does not see more, more for the practice of a small scale.The study is mainly based on a certain level of first-class hospital orthopedic treatment of past experience, after orthopedic experts many discussions, selected the incidence of a disease, with less variation and treatment experience of nucleus pulposus and treatment effect of lumbar intervertebral disc protrusion with excision as target diseases, to develop a suitable path of the disease.Research Purpose:Through repeated demonstration and sufficiently investigation, we select the discectomy of lumbar disc herniation as the clinical pathway subject. Then we formulate the scheme of clinical pathways of it. Undergoing clinical implementations and consistent improvements and perfections, we compare it with the control group. By the means of the applications of clinical pathway in the discectomy of lumbar disc herniation, we study the impacts on the length of patients hospital duration and their hospitalization expenses, and also study patients satisfaction on the process and effectiveness of the treatment before and after the clinical pathways. It is assured that patients could get the right treatment services at the right time and in the right place, in order to achieve the best clinical outcomes.Methods1.1Groups:This study on March1,2012to September1,2013, line for the extraction of nucleus pulposus of lumbar disc prolapse patients367cases, the observation group. The patients in the hospital when he was by the nurse and competent doctors for its clinical pathway chart, according to the time order of path to provide treatment and care for the patient. Control group is January1,2010to June1,2011line with excision of nucleus pulposus of lumbar disc herniation,389cases.1.2Data processing and analysisFirst team for a patient satisfaction survey, and will be distributed questionnaires before the patient discharged from hospital, the questionnaire of all involved in the project, including three evaluation grades, satisfied, basic satisfaction, unsatisfied respectively; second, by getting the contact information from the information files retained during hospital duration, we made call visits to the patients and their families, so as to get the results; finally, through the hospital inpatient information database, we could get patients information about the length of their hospital duration and medical expenses, and then obtain the average length of duration and average cost of hospitalization for each group.1.3Statistical MethodsThe data were analyzed by χ2test and t-test. The study descriptively analyzed the basic information of patients with lumbar disc herniation(gender, age, education and ginseng, etc), Hospitalization days and cost, complications after the operation, application of antibiotics and patient satisfaction, and so on. The data was recorded by the Excel, and analyzed by the SPSS13.0software. The statistics were calculated by χ2test and p<0.05was considered statistically significant.The main ResultsAfter clinical pathways on the discectomy of lumbar disc herniation were implemented, the average length of hospital duration decreased from11.1days to8.5days, the average medical cost dropped from29247yuan to20015yuan, patient satisfaction increased from91.52%to98.09%, postoperative complication rate was reduced from3.34%to1.36%, and the usage of antimicrobial drugs decreased from28.25%to5.72%. Each index displayed a significant difference.Conclusions and suggestionsConclusions acquired from the implementation of clinical pathway on the discectomy of lumbar disc herniation:1. After admission and preoperative assessment, before the operation to be surgery patients for health knowledge education, to provide quality care for patients, reduce the postoperative complications, reduce the patient’s pain; Application of antimicrobial drugs significantly reduce, the application more rationalization, save medical resources; The patient’s hospital stay decreased significantly, hospitalization costs significantly reduced, easing the burden on the patient’s family, increase the social benefits.2. Medical behavior standardization, humanization service process, the reasonable demand for patients as much as possible to meet, obviously improve the patients’ satisfaction; This study also the implementation of clinical pathway for other diseases, to provide experience and related practice basis. |
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