Development of a Clinical Pathway for Gastrectomy and Effect of Its Implementation in One Tertiary Hospital

Kim, Eun-Hee; Kim, Chul-Gyu; Lee, Sun-Gyo; Kim, Soon-Duck; Lee, Hae-Ok; Kwon, Jeong-Soon; Lee, Kyeong-Mi; Lee, Min-Mi; Sim, Soon-Mi; Lyu, Yong-Man; Sin, Jong-Sik; Kang, Eun-Hee; Lee, Sang-Il; Kim, Byung-Sik; Oh, Sung-Tae; Yook, Jeong-Hwan; Park, Su-Kil

Journal of Korean Society Quality Assurance Health Care 2003;10(2): 176.
Published online December 30, 2003.

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희¹, 김철규¹, 이순교¹, 김순덕², 이혜옥², 권정순², 이경미², 이민미², 심순미², 유용만³, 신종식³, 강은희⁴, 이상일¹, 김병식⁵, 오성태⁵, 육정환⁵, 박수길¹

¹서울아산병원 CPI팀
²서울아산병원 간호부
³서울아산병원 의료정보팀
⁴서울아산병원 영양팀
⁵울산의대 외과

Development of a Clinical Pathway for Gastrectomy and Effect of Its Implementation in One Tertiary Hospital

Eun-Hee Kim¹, Chul-Gyu Kim¹, Sun-Gyo Lee¹, Soon-Duck Kim², Hae-Ok Lee², Jeong-Soon Kwon², Kyeong-Mi Lee², Min-Mi Lee², Soon-Mi Sim², Yong-Man Lyu³, Jong-Sik Sin³, Eun-Hee Kang⁴, Sang-Il Lee¹, Byung-Sik Kim⁵, Sung-Tae Oh⁵, Jeong-Hwan Yook⁵, Su-Kil Park¹

¹Clinical Performance Improvement Team, Asan Medical Center
²Department of Nursing, Asan Medical Center
³Department of Information Management, Asan Medical Center
⁴Department of Dietary and Nutrition, Asan Medical Center
⁵General Surgery, College of Medicine, University of Ulsan

Abstract

Background
Gastric cancer is the most common malignant tumor in Korea. Surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for reducing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients.
Methods
The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and the unplanned readmission rate between the pre-pathway group (n=67) and the post-pathway group (n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway.
Results
The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days (p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was not statistically significant (p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group and 0% in the post-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korean hospital settings.

Key words Clinical pathway;Gastrectomy;