Development of Critical Paths for Appendectomy

Kim, Yong-Soon; Park, Jee-Won; Park, Yon-Ok; Cho, Eun-Sook; Kim, Myung-Wook

Journal of Korean Society Quality Assurance Health Care 1996;2(2): 32.
Published online April 30, 1996.

표준 진료 지침서(Critical Paths) 개발에 관한 연구 - 충수절제술(Appendectomy) 환자용 -

김용순¹, 박지원¹, 박연옥², 조은숙², 김명욱³

¹아주대학교 의과대학 간호학과
²아주대학교 병원 의료지원부
³아주대학교 의과대학 외과학 교실

Development of Critical Paths for Appendectomy

Yong-Soon Kim¹, Jee-Won Park¹, Yon-Ok Park², Eun-Sook Cho², Myung-Wook Kim³

¹Department of Nursing, School of medicine, AJOU University
²Department of Nursing, AJOU University Hospital
³Department of General Surgery, School of medicine, AJOU University

Abstract

Background
A critical path defines an optimal sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to better utilize resources, maximize quality of care, and minimize delays. It can be thought of as a visualization of the patient care process. In this study, a review of appendectomy patient records was undertaken to identify a critical path for the management of this treatment.
Methods
For this study, records of patients under 15 or over 65 years of age were excluded ; cases where the patient was pregnant, or where complications developed were also excluded. The remaining 21 cases were divided into two categories according to the indication for appendectomy : for acute appendicitis, and for perforated appendix or drainage of periappendical abscess. The time frame for the review was from patient examination immediately prior to operation, through discharge. The study team was composed of a surgeon, research head nurse, education head nurse, surgical part head nurse, and medical recorder. Following their review of the 21 charts, the team determined an appropriate progression and schedule for an appendectomy.
Result
Through the chart and literature review, the following aspects of the care process were identified as typical and tracked : monitoring/assessment, treatment, lines/drains, medication, activity, diet, tests and patient education.
Conclusion
From this study, the design team determined two separate critical paths : one for appendectomy only, and one for appendectomy plus drainage. Next, these paths must be validated and fine-tuned through clinical implementation. In addition, a comparison of our design with the critical paths determined at other hospitals would be extremely valuable for advancing research in this area. Lastly, the critical path approach to improving patient care and maximizing hospital resources should be applied to other procedures.