The Development and Implementation of the Clinical Pathway: Pediatric Femoral and Inguinal Hernia Repair

目的：研究臨床路徑的發展與實施，以及在醫療成本控制、病患住院日數、醫療品質 變異控制、文書記錄時間、及護理標準的影響。材料與方法：本研究以台北某醫學中 心為研究場所，先發展臨床路徑並進行臨床測試之後，進入試用階段，再次經過評估 而成為正式病歷；研究樣本為臨床路徑實施前一年（86.7-87.6，共得230個案）接受 腹股溝疝氣修補的兒童，並請護理人員對於臨床路徑實施給予評值。結果：1.可降低 病童住院日數，實施臨床路徑前平均住院日數為3.22天，實施臨床路徑後平均住院日 數為1.98天，減少1.24天；2.節省醫院的醫療成本花費，共節省平均住院費用35元、 藥費329元、手術費324元；3.降低臨床護理人員的文書工作負荷，記錄時間從原先3. 3分/班降為1.8分/班；4.可監測此路徑的變異狀況以確保病童獲得較高的醫療品質； 5.並建立護理標準使護理工作所依循，研究對象中有92.6%的護理人員對於路徑單取 代護理記錄感到滿意。結論：臨床路徑的實施，的確有助醫院面對全民建保於1995年 施行後的醫療變動，尤其是在成本效益的控制、監測、提供標準化的醫療服務、減少 護理文書記錄時間、及確保病患的醫療品質方面，是值得肯定及推行的政策。 Objective: This research was to study the development and effects of a clinical pathway, in these aspects of medical expenses, length of stay in the hospital, quality of medical care, record-keeping workload, and establishment of nursing standard. Materials and Methods: Consistent with such goals , we established a clinical pathway for Pediatric Femoral and Inguinal Hernia Repaired Surgery. Retrospective and prospective survey were used to study two patient groups: 221 cases were collected from one year duration before clinical pathway adopted, 230 cases from one year duration after clinical pathway adopted. Results: Implementation of the Pediatric Femoral and Inguinal Hernia Repaired Surgery pathway included: 1 . Shortening the hospital stay for children (from 3.22 days to 1.98 days). 2. Decreasing in medical expenses (drug expenses from 812 NT dollars to 483 NT dollars/case). 3. Decreasing record record-keeping workload for nursing staff (from 3.3 min to 1.8 min/shift for each patient). 4. Monitoring the quality of medical care using variance recording. 5. Developing a nursing standard that reaffirms quality patient care. Conclusions: The implementation of this clinical pathway is a positive result of National Health Insurance. It be suggested to apply clinical pathway to other health problem conditions. Besides , the discharge follow up and satisfaction of patients received clinical pathway could be continued to be other good research topics.