Journal List > J Korean Acad Nurs Adm > v.17(1) > 1051623

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



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


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.


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.


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.

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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