The Establishment And Application Of Clinical Pathway In Skin Cancer Surgery

Objective To develop the standard hospitalization procedures for skin cancer surgery,develop skin cancer CP(clinical pathway) form, explore how to more scientifically develop and implement CP through analysis of the application results of CP in skin cancer surgery and its role in(1)regulating medical practices and improving medical quality,(2)controlling medical costs and reducing the hospitalization time and costs,(3) implementing health education among patients and improving their health knowledge awareness,(4)making rational use of antibiotics,(5)as well as increasing transparency, reducing disputes, enhancing patient satisfaction and other aspects,record problems and variations in the application process, and make an analysis and give reasonable suggestions and improvements according to the controllability and sources of variations.Method I.This study was completed in two stages. 1st stage: used retrospective analysis to obtain the medical record information of 130 cases of hospitalized patients receiving skin cancer surgery in the Plastic Surgery Department of the First AffiliatedHospital of Zhengzhou University from May 2012 to May 2014, developed the standard hospitalization procedures for skin cancer surgery through relevant data analysis, evidence-based medicine, referring to the relevant CP text, consulting professional medical personnel and other methods, developed the CP text for skin cancer surgery, and calculated the standard hospitalization time and costs; 2nd stage:used the randomized controlled trial method to randomly divide 108 hospitalized patients receiving skin cancer surgery from June 2014 to December 2015 into the experimental group(72 cases) and the control group(36 cases) in accordance with the entry and exit criteria. General descriptive statistics, one-way analysis of variance(ANOVA), ? 2 test, t test and rank sum test were applied to conduct statistical analysis on each data with SPSS 17.0(statistical package for the social science). The significance level ? = 0.05. By comparing and analyzing the relevant indexes, the application effect, relevant problems and variation factors were obtained.Results This study through the retrospective analysis of the First Affiliated Hospital of Zhengzhou University of 130 cases of skin cancer surgery patients with medical record information, determined the standard hospitalization. Each CP form used the“item-time” format to standardize the specific treatment items in the time frame.The items mainly include diagnosis and treatment work, key medical advice, main nursing work, condition variation record, nurses' signature and doctors' signature.In this study, the comparison of the skin cancer surgery CP in the experimental group and control group showed that the general information difference between the experimental group and control group was not statistically significant(P> 0.05) and of comparability; the total hospitalization time of the experimental group was lower than that of the control group(P <0.01); The total hospitalization costs of the experimental group were lower than that of the control group, indicating that the difference was statistically significant(P <0.05); before the skin cancer surgery,among the 14 items in the patient satisfaction survey form, in addition to the evaluation of “medical staff technical level” “the doctor cares about the patientlevel”showing no statistical significance(P> 0.05), the evaluation on other items in the experimental group was higher than that in the control group(P <0.05, P <0.01);before the surgery, the SCL-90 anxiety factor scoring of the experimental group was significantly lower than that of the control group(P <0.01), and after the surgery, the SCL-90 anxiety factor scoring of both groups decreased, and the SCL-90 anxiety factor scoring of the experimental group was still significantly lower than that of the control group(P <0.01); the health education effect before discharge of the experimental group was significantly higher than that of the control group(P <0.01)and with statistical significance; there were fewer postoperative complications in both groups, and statistical analysis could not be conducted.Conclusion1. In this study, the development of skin cancer surgery CP applied evidence-based medicine, integrated multi-disciplinary and multi-specialty clinical intervention measures and has scientificity, normalization, and operability.2. In this study, the application and implementation of skin cancer surgery CP provides a certain reference value in the development of single disease CP in plastic surgery.3. Preparation and implementation of skin cancer CP not only brings tangible benefits to patients, but also brings benefits to the hospital and society, and has scientific and practical.