Evaluation Of Clinical Pathway Implementation And Analysis Of Variance Factors In Patients With Minor Burns

Background:Clinical pathway refers to a standard plan of diagnosis and treatment,which is formed through multi-disciplinary evolution and fusion of clinical medicine,evidence-based medicine,economics,social psychology,etc.,with the aim of optimizing the allocation of resources and standardizing medical activities.It embodies the modern medical idea of"taking the patient as the center"^[1-2].The practice of nearly half a century at home and abroad has proved that cp has achieved remarkable results in ensuring the quality and safety of medical treatment and making rational use of medical resources^[3].However,in the process of clinical pathway implementation,in view of the hospital conditions,the professional skills of the medical staff and the individual differences of the patients,some patients deviate from the planned path flow,and this situation is a variation^[1].While the presence of variations in CP is normal and permissible,they are detected,documented,handled,and analyzed as soon as possible.It will help to find the weak link of cp in our unit,And then optimize and correct the path plan,and finally achieve the goal of promoting the continuous improvement of cp quality^[4].Objective:This study compared the differences between clinical pathway therapy and common experience therapy by collecting the data during the course of implementing"clinical pathway of mild burn treatment",and preliminarily analyzed the factors of variation of clinical pathway cases.The corresponding countermeasures are put forward to provide reference data and experience support for exploring and perfecting the cp model which is suitable for the actual situation of our hospital.Methods:1.Because the Ministry of Health has no clinical path for burn treatment at present,according to our own actual situation,the"clinical path of mild burn"has been formulated.The path consists of three stages:admission date,hospitalization treatment,and discharge date.According to certain inclusion criteria,70 patients with mild burn were selected from January 2017 to April in our department.The selected patients were randomly divided into control group?35 cases?and observation group?35 cases?.The former was treated with common mode and the latter was treated with cp mode.To compare the difference of clinical efficacy between the two groups and verify the superiority of path-therapy.2.Selected January 2017-January 2018,124 patients who entered"clinical path management of mild burn"in our department were retrospectively investigated.The complete group and the exit group were statistically described and analyzed according to the source of variation.Logistic regression analysis was used to analyze the risk factors affecting the completion of clinical pathway.The statistical analysis of spss20.0 software package was used to analyze the relationship between the risk factors and the risk factors of clinical pathway completion.There was significant difference between the two groups?P<0.05?.Results:1.The first part of the study included 70 cases,67 effective cases,including 33 cases in control group and 34 cases in clinical pathway group.There was no significant difference in age,sex,nationality,payment method,burn type,burn site,burn area and complications between the two groups?P>0.05?.The cost of hospitalization,the days of antibiotic use,the healing rate of wound on the 5th and 7th day after admission in the clinical path group were all improved compared with the general treatment group,and the difference was statistically significant?P<0.05?;But the number of days of hospitalization,third days after admission,Ninth days of wound healing rate,the incidence of complications,the difference was not statistically significant?P>0.05?.2.In the second part of the study,119 cases of effective path cases were included,110 cases of completed path medical records,the path completion rate of84%,reflecting that the overall implementation of cp in our hospital is good,the completion rate after the path is 84%>70%,which shows that the overall situation of cp implementation in our hospital is good.Meet the national requirements.However,the degree of compliance is only 51.9,mainly related to the design defects of the form.In the completion path group,the medical staff accounted for 39.57%,the patient 32.37%,the disease 17.99%,the hospital system 10.07%,the controllable change 49.64%and the uncontrollable variation50.36%.In the exit path group,the medical staff accounted for 22.22%,the patient 52.78%,the disease 25%,the hospital system 0%,the controllable change22.22%,the uncontrollable variation 77.78%."complication"is the main risk factor to complete the clinical pathway?OR=31.407,P<0.05?,and"patient compliance"is the main protective factor to complete the clinical pathway?OR=0.214,P<0.05?.Conclusions:1.The clinical path standardizes the behavior of diagnosis and treatment,changes the quality of medical treatment from terminal management to link management,reduces the cost of hospitalization,speeds up the process of wound healing,Shortening the days of antibiotic use has remarkable effect.2.It is feasible to use CP to control the quality of patients with mild burn,but we should further improve the ability of medical staff,improve the form of path,enhance the coordination among medical staff,strengthen the communication between doctors and patients,and establish a perfect clinical work system.Finally,the purpose of continuous quality improvement of clinical pathway is achieved.