Journal List > Asian Oncol Nurs > v.12(3) > 1081735

Jung, Choi, Kim, Kim, and Lee: The Effects and Variances of the Critical Pathway of Laparoscopic Colon Resection in Colon Cancer Patients

Abstract

Purpose

To investigate the effectiveness and variance of a critical pathway (CP) for laparoscopic colon resection in colon cancer patients, and nurses'satisfaction with the CP.

Methods

A CP for laparoscopic colon resection was applied to the CP-group that included 50 patients, who underwent elective colon resection between March and May, 2011. The non-CP group included 51 patients who had the same operation without the CP applied from March to May, 2010.

Results

The means of length of hospital stay were 11.7 and 7.3 days (p<.001) and the lengths of postoperative hospital stay were 8.6 and 5.1 days (p<.001) in the non-CP group and CP group, respectively. There was no significant difference between two groups for total healthcare costs, pain score, complications, or emergency room visits within 30 days after discharge. By examining variances of the CP, there were 162 variances and the most frequent cause was patient's condition. Nurses'satisfaction with the use of CP was favorable and the mean score of satisfaction was 3.76 on the 5 point Likert scale.

Conclusion

There are clear benefits to use of CP, resulting in standardized and effective patient care. In conclusion, analysis of variance data can assist in evaluating and revising CP for optimal care and reducing variances.

Figures and Tables

Table 1
Demographic and Disease-related Characteristics between Non-CP Group and CP Group (N=101)
aon-12-204-i001

BMI=body mass index.

Table 2
Comparison of Outcomes between Non-CP Group and CP Group (N=101)
aon-12-204-i002

Pain score is recorded on the day of discharge with the Numerical Pain Intensity Scale (NPIS). NPIS; 11-point numerical rating scale, with 0="No pain" and 10="Pain as bad as it could be".

Table 3
Comparison of Postoperative Complications between Non-CP Group and CP Group (N=101)
aon-12-204-i003

*Atelectasis, Pneumonia; Urinary retention, Urinary tract infection; Multiple counts in one patient allowed; §Fisher's exact test.

Table 4
Contents and Frequency of Variance
aon-12-204-i004

Notes

This article is a condensed form of the first author's master's thesis from Yonsei University.

References

1. Donabedian A. The quality of care. How can it be assessed. JAMA. 1988. 260:1743–1748.
crossref
2. Darer J, Pronovost P, Bass EB. Use and evaluation of critical pathways in hospitals. Eff Clin Pract. 2002. 5:114–119.
3. Kurtin P, Stucky E. Standardize to excellence: improving the quality and safety of care with clinical pathways. Pediatr Clin North Am. 2009. 56:893–904.
crossref
4. Allen D, Gillen E, Rixson L. Systematic review of the effectiveness of integrated care pathways: what works, for whom, in which circumstances? Int J Evid Based Healthc. 2009. 7(2):61–74.
5. Coffey RJ, Richards JS, Remmert CS, LeRoy SS, Schoville RR, Baldwin PJ. An introduction to critical paths. Qual Manag Health Care. 2005. 14(1):46–55.
crossref
6. Kim EK, Chang HS. Critical pathway. 2001. Seoul: Korea Health Industry Development Institute.
7. Lee DH. Development and application of critical pathway for patients undergoing endoscopic colonic polypectomy [dissertation]. 2007. Seoul: Korea Univ..
8. Chang CH. Effects of critical pathway for hysterectomy patients [dissertation]. 2004. Seoul: Yonsei Univ..
9. Sung YH. Development of a case management model and its application: for the laminectomy patients [dissertation]. 2000. Seoul: Chung-Ang Univ..
10. Hwang SJ. An effect of the decrease in length of stay in a millitary hospital [dissertation]. 2004. Seoul: Seoul National Univ..
11. Hunter B, Segrott J. Re-mapping client journeys and professional identities: a review of the literature on clinical pathways. Int J Nurs Stud. 2008. 45:608–625.
crossref
12. Cheah J. Development and implementation of a clinical pathway programme in an acute care general hospital in Singapore. Int J Qual Health Care. 2000. 12:403–412.
crossref
13. Song YH. The effects of a critical pathway of appendectomy in patients on a military hospital [dissertation]. 2002. Seoul: Yonsei Univ..
14. Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005. 24:466–477.
crossref
15. Hurt LW. Care management: providing a connecting link. Nurs Manage. 1995. 26(11):27–33.
crossref
16. Delaney CP, Fazio VW, Senagore AJ, Robinson B, Halverson AL, Remzi FH. 'Fast track' postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg. 2001. 88:1533–1538.
crossref
17. Kim EO, Kwon SM. Effects of a standardized critical pathway in gastrectomy patients in a general hospital. Korean J Hosp Manage. 2004. 9(3):128–142.
18. Kiyama T, Tajiri T, Yoshiyuki T, Mitsuhashi K, Ise Y, Mizutani T, et al. Clinical significance of a standardized clinical pathway in gastrectomy patients. J Nippon Med Sch. 2003. 70:263–269.
crossref
19. Rotter T, Kugler J, Koch R, Gothe H, Twork S, van Oostrum JM, et al. A systematic review and meta-analysis of the effects of clinical pathways on length of stay, hospital costs and patient outcomes. BMC Health Serv Res. 2008. 8:265–279.
crossref
20. Rotter T, Kinsman L, James E, Machotta A, Gothe H, Willis J, et al. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev. 2010. (3):CD006632.
crossref
21. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. 2011. (2):CD007635.
crossref
22. Gouvas N, Tan E, Windsor A, Xynos E, Tekkis PP. Fast-track vs standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis. 2009. 24:1119–1131.
crossref
23. Kong JH. Development of case management system during hospitalization and analysis of management effect: focused on patients with laminectomy [dissertation]. 2004. Seoul: Yonsei Univ..
24. Joh YG, Lee JE, Yoo SH, Kim SH, Jeong GY, Chung CS, et al. The effects of a standardized postoperative enhanced recovery program after a laparoscopic colorectal resection in regard to patients' recovery and clinical outcomes. J Korean Soc Coloproctol. 2010. 26:225–232.
crossref
25. Steele DJ, Hamilton E, Arnaout MA. A case management model to improve hemodialysis outpatient outcomes. Hemodial Int. 2007. 11:247–251.
crossref
26. Cohen EL, Cesta TG. Case management in the acute care setting. A model for health care reform. J Case Manag. 1994. 3:110–116.
27. Gurzick M, Kesten KS. The impact of clinical nurse specialists on clinical pathways in the application of evidence-based practice. J Prof Nurs. 2010. 26(1):42–48.
crossref
28. Shin EY. Nursing case management program development for the elderly at hospital [dissertation]. 2002. Seoul: Seoul National Univ..
29. Chung KH, Joo JL, Chang HS. The effect of Critical Pathway on the patients with Cesarean section. J Korean Acad Nurs Adm. 2006. 6:211–225.
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