Critical Pathway Implementation for Minor Motor Vehicle Trauma Patients

다국어 초록 (Multilingual Abstract)

Purpose: The high rate of road traffic crashes and rising medical costs are critical health care problems in Korea as well as in the United States. To reduce the medical cost of minor traffic accidents, we hypothesized that implementation of a 7-day critical pathway (CP) for minor car accident patients (MCP) would decrease medical costs and hospitalization time without lowering patient satisfaction level.
Methods: A pretest-posttest experimental design was used to verify the effects of CP on MCP, from June 1 to December 31, 2010. A 7-day admission schedule with daily predefined order communication system (OCS) order set was implementated for MCP. On the day of discharge,MCP completed a satisfaction survey, and the total medical cost and cost per day were calculated. Satisfaction with physician and nursing care were also surveyed using the Brief Encounter Psycho-Social Instrument-Korea tool.
Results: Overall rating did not differ in patients processed normally and using the CP, but length of admission was reduced in CP patients. Total medical costs were not different in either group but cost per day was higher in the CP group. Satisfaction with physicians, but not nurses, satisfaction was improved after CP implementation.
Conclusion: A critical pathway for MCP reduces length of admission without decreasing patient satisfaction. Total medical costs are not changed after CP implementation but cost per day is significantly increased. Improved job satisfaction in physician but not for nurses was observed after CP implementation. It seems that CP is a effective tool for MCP.

참고문헌 (Reference)

1 "http://www.rota.or.kr/Work/Code/RotaSafety/RotaSafety18_list.jsp"

2 "http://www.khidi.or.kr/etcsite/medicalnotice.do?mode/"

3 Guezo J, "Total abdominal hysterectomy: development of apatient-centred care pathway" 18 : 38-42, 2003

4 Yim JH, "The validity of modified Korean-translated BEPSI asinstrument of stress measurement in outpatient clinic" 17 : 42-53, 1996

5 Browne GJ, "The benefits of using clinical pathways for managingacute paediatric illness in an emergency department" 21 : 50-55, 2001

6 Lemmens L, "Systematic review: indicators to evaluate effectiveness ofclinical pathways for gastrointestinal surgery" 14 : 880-887, 2008

7 Yang BM, "Road traffic accidents and policy interventionsin Korea" 10 : 89-94, 2003

8 Sandrick K, "Out in front. Managed care helps push clinicalguidelines forward" 67 : 30-31, 1993

9 Latini EE, "Obtaining consistent quality patientcare for the trauma patient by using a critical pathway" 15 : 51-55, 1992

10 Dutto L, "Nontraumatic headaches in the emergencydepartment: evaluation of a clinical pathway" 49 : 1174-1185, 2009

11 신상도, "New Injury Severity Score(NISS)에 기초한 교통사고 손상 피라미드 연구" 대한응급의학회 14 (14): 192-197, 2003

12 Furtado MV, "Influence of implementationof a chest pain unit on acute coronary syndrome outcomes" 40 : 557-564, 2011

13 Naumann RB, "Incidence and total lifetime costs of motorvehicle-related fatal and nonfatal injury by road user type,United States, 2005" 11 : 353-360, 2010

14 Walker A, "Evaluation of adiabetes referral pathway for the management of hypoglycaemiafollowing emergency contact with the ambulanceservice to a diabetes specialist nurse team" 23 : 449-451, 2006

15 Kusaka K, "Effects of introducing acritical path method to standardize treatment and nursingfor early discharge from acute psychiatry unit" 14 : 69-80, 2006

16 Sloan J, "Effect of a pathway bundle on length ofstay" 26 : 479-483, 2009

17 Pearson SD, "Critical pathwaysas a strategy for improving care: problems and potential" 123 : 941-948, 1995

18 Lemmens L, "Clinical and organizationalcontent of clinical pathways for digestive surgery: a systematicreview" 26 : 91-99, 2009

19 Webster TM, "A clinical pathway forlaparoscopic pyeloplasty decreases length of stay" 173 : 2081-2084, 2005