Reduction of Length of Stay in Emergency Room by Using Critical Pathway for Stroke Patients

Yeo Ok Yun; Min Young Kim; Woo Jeong Kim; Young Joon Kang; Ju Ok Park; Kyung Hye Park

doi:10.11111/jkana.2011.17.1.66

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Yun, Kim, Kim, Kang, Park, and Park: Reduction of Length of Stay in Emergency Room by Using Critical Pathway for Stroke Patients

Original Article

Journal of Korean Academy of Nursing Administration

Journal of Korean Academy of Nursing Administration 2011; 17(1): 66-73.

Published online: 31 March 2011

DOI: https://doi.org/10.11111/jkana.2011.17.1.66

Reduction of Length of Stay in Emergency Room by Using Critical Pathway for Stroke Patients

Yeo Ok Yun¹, Min Young Kim², Woo Jeong Kim³, Young Joon Kang³, Ju Ok Park³, Kyung Hye Park⁴

¹Nurse Manager, Emergency Medical Center, Jeju National University Hospital, Korea.

²Instructor, College of Nursing, Jeju National University, Korea.

³Assistant Professor, Department of Emergency Medicine, School of Medicine, Jeju National University, Korea.

⁴Instructor, Department of Emergency Medicine, School of Medicine, Jeju National University, Korea.

Correspondence: Kim, Min Young. Instructor, College of Nursing, Jeju National University 1, Ara 1dong, Jeju city, Jeju Special Self-Governing Province, 690-756, Korea. Tel: 82-64-754-3750, Fax: 82-64-702-2686, musemy2@hanmail.net

Received 12 November 2010 Revised 18 January 2011 Accepted 18 January 2011

Abstract

Purpose

The purpose of this study was to demonstrate effects of a critical pathway (CP) for stroke patients seen in emergency rooms (ER).

Methods

The CP developed by the CP committee consisted of 8 criteria: behavior of doctors and nurses, laboratory tests, Image testing, medication, treatment, activity, and nutrition. According to application of CP, a control group (n=17) and experimental group (n=17) were defined. Time was checked by the electronic medical records.

Results

Use of CP for stroke patients in the ER, resulted in a decreased length of stay in ER (t=2.341, p=.026), and time required for image testing (t=2.623, p=.021), and an increased number of patients using rtPA (χ²=4.802, p=.049). Time required for neurology doctor contact, for neurology doctor to see patient in the ER, and for report of blood tests decreased, but there were no statistical significance.

Conclusion

Quick responses are most important in the ER, so CP for these patients is a very effective patient management tool. To reduce delay in stroke diagnosis, continuous education programs for similar symptoms are necessary. CPs for other patients in the ER should be developed, and studies on cost and satisfaction, as well as length of stay, should be done.

Keywords: Critical pathways, Length of stay, Stroke, Emergency service

Figures and Tables

Table 1

Schedule for this study

C: control group, CP: critical pathway, E: experimental group

Table 2

Checklist for this study

Exam: examination, ED: emergency department, Dr.: doctor, NR: neurology, ER: emergency room,

CBC: complete blood count, CHE: chemistry, e: eloctrolyte, Coa: coagulation

Table 3

Critical pathway for acute stroke patients in emergency room

ED: emergency department, FAT: first abnormal time LNT: last normal time, BP: blood pressure, MRI: magnetic resonance imaging,

rtPA: recombinant tissue plasminogen activator, NR: neurology, NIHSS: National Institute of Health Stroke Scale,

MSE: Mental Status Examination, CNE: cranial nerve examination, DWI: derfusion-weighted imaging, PWI: perfusion-weighted imaging,

SU: stroke unit, PCT: pre-enhanced computed tomography, IV: intravenous, NPO: nothing by mouth

Table 4

Cross-tabulation of this study (n=32)

Table 5

Effects of critical pathway for acute stroke patients

Exam: examination, EM: emergency medicine, Dr.: doctor, NR: neurology, ER: emergency room,

CHE: chemistry, e: eloctrolyte, Coa: coagulation, rtPA: recombinant tissue plasminogen activator

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