ObjectiveTo explore the effect of clinical pathway in peri-operative nursing management of patients with esophageal carcinoma. MethodsA total of 120 patients with esophageal cancer who underwent the operation between January 2010 and April 2012 were divided into control group and trial group. the patients in control group was given conventional esophageal carcinoma peri-operative management; while the ones in the trial group received clinical pathway standardized management. The hospitalization days, costs of hospitalization, complications, satisfaction of the patients and families were compared between the two groups. ResultsThe length of hospitalization days and costs in the trial group were lower than those in the control group (P<0.01); the patients and families satisfaction in the trial group was superior to the control group (P<0.05); the difference in complications occurrence between the two groups was not significant (P>0.05). ConclusionThe clinical pathway of peri-operative nursing management for patients with esophageal cancer could effectively decrease the costs, improve satisfaction of the patients and families, and ensure the quality of care and improve the nursing efficiency.
Chronic obstructive pulmonary disease (COPD) is one of the major chronic diseases that seriously endanger the health of residents in our country. Exercise is one of the effective interventions to improve the cardiopulmonary function and quality of life of COPD patients. An exercise prescription specifies the frequency, intensity, duration, mode, total exercise volume, and progression of exercise, forming a clear - purpose and systematic exercise guidance plan. Clinical pathways standardize and proceduralize the patient's diagnosis and treatment process. Developing an exercise prescription for the entire process of issuing and implementing exercise prescriptions for COPD patients helps to promote the application of exercise prescriptions and assist in the implementation of related work in primary - level medical institutions. Therefore, we invited a number of COPD experts and sports medicine experts to develop this clinical pathway in combination with domestic and international guidelines, consensuses, and personal experience. Its aims are to simplify the exercise prescription development process, reduce the required level of expertise, enhance the capacity of primary healthcare institutions, and facilitate the application of exercise prescriptions within these settings.
ObjectivesTo analyze the citation of evidence in traditional Chinese medicine (TCM) clinical pathways in China, and to provide suggestions for future development and revision of TCM clinical pathways.MethodsTCM clinical pathways released on the websites of national administration of TCM and China association of Chinese medicine were obtained, with the retrieval time limit to June 2019. Two researchers separately utilized the Excel to extract data and performed a descriptive analysis.ResultsA total of 405 TCM clinical pathways were included, involving internal medicine, surgery, gynecology and pediatrics. Internal medicine accounted for the largest proportion of the TCM clinical pathways (133). All the 405 pathways cited references as evidence, among which the maximum and minimum quantities of cited references were 11 and 1, respectively, and the median was 3. More than 90% of the TCM clinical pathways cited the evidence in the parts of diagnosis and efficacy evaluation. For parts of TCM and western medicine treatment, the proportion of TCM clinical pathways which cited evidence was less than 75%; for parts of rehabilitation and nursing, the proportion of TCM clinical pathways which cited evidence was less than 2%. The types of evidence being cited were standard indicators (683), clinical practice guidelines (488), textbooks (236), consensus opinions, ancient books and clinical surveys. The released time was reported in 89.25% of the cited evidence; the largest time interval was between the release time of the standard indicators (evidence) and that of the TCM pathways. Among the evidence released more than 15 years before the release of the TCM pathways, the proportion of standard indicators was the highest (57.12%).ConclusionsThe published TCM clinical pathways are all developed based on evidence, however, the evidence citation ratio in different parts varies greatly. In some TCM clinical pathways, the cited evidences are not reported normatively, and some evidence are poor in timeliness.
ObjectiveTo introduce the clinical pathway for geriatric hip fracture regulated by our hospital and report the five-year outcomes after the implementation of the pathway. MethodsThe geriatric hip fracture patients treated between September 2003 and August 2012 were followed up. We did not implement the clinical pathway until January 2007. Statistical analysis was done to evaluate the effect of the clinical pathway on patient outcomes by comparing rate of complication, mortality, and length of hospital stay before and after the implementation of the clinical pathway. ResultsAfter the implementation of the pathway, the in-hospital mortality, one-year mortality and the rate of complication were significantly lower. Besides, the time from admission to operation and the total length of stay in hospital were obviously shortened. ConclusionThe use of clinical pathway for geriatric hip fracture can reduce the rate of complication and mortality, and shorten hospital stay, and the five-year outcomes after the implementation of the pathway are satisfying.
Based on the practice of large tertiary hospitals in clinical pathway (CP) entrance management, we implemented a fine CP management model with standardized clinical diagnosis and treatment, and encouraged the department to continuously optimize the path form, expand CP coverage and improve the entry rate in a flexible path. Combining PDCA cycles with CP management, it can promote the realization of management goals and achieve continuous improvement, while providing operable (repeatable) methods to the practice of hospital CP management.
Although day surgery started late in China, its development momentum is strong. Due to the advantages of day surgery, the requirements of new medical reform and the promotion of national policies, thousands of hospitals have tried this innovative operation management mode in the past decade, presenting a picture of blooming flowers in full bloom. However, due to the lack of unified management standards for day surgery in China, there are still many practical problems in China, such as inconsistent definitions, inconsistent connotations and diversified management modes. It is believed that the day surgery will develop healthily and sustainably in China after the relevant management standards are formulated at the national level. Based on the development of day surgery at home and abroad, this paper discusses the expectation and prospect of day surgery in China.
Day surgery has become an international and domestic medical service model, and it has received more and more attention from hospital administrators in terms of innovation and practical benefits for hospital management. However, from the perspective of standardization management, management norms have still been wanted. This paper introduces the general specification of clinical pathway management for day surgery in West China Hospital of Sichuan University, in order to provide reference for subsequent research, and hopes to provide certain standard models to provide reference for clinical pathway management practice.
Objective To evaluate the effect of clinical pathway (CP) teaching methods versus traditional methods in nursing clinical teaching. Methods The following electronic databases as PubMed, EMBASE, The Cochrane Library, CBM and CNKI were retrieved on computer from their establishment to April 2011 to search for randomized controlled trials (RCTs) of comparing CP with traditional methods in nursing clinical teaching. The methodological quality of the included RCTs was assessed by two reviewers independently according to the scale of criteria for methodological quality developed by Smits PB, and the meta-analysis was conducted by using the Cochrane Collaboration’s RevMan5.1 software. Results A total of 12 RCTs involving 1 269 participants were included, and nine of them were of high quality. The meta-analyses showed that compared with the traditional teaching method, the CP teaching tended to be superior (Plt;0.05) in improving nursing students’ objective knowledge, nursing operating skills, professional ability and satisfaction with teaching methods, and in improving patients’ satisfaction as well. Conclusion The clinical pathway teaching method is a scientific teaching model in nursing clinical teaching; it standardizes the teaching procedure, promotes students’ active learning and further enhances the teaching effect. But it is necessary to unify the method of assessment with more researches. In addition, researchers should pay more attention to improving the comprehensive quality of nursing students.
Strengthening the management and evaluation of clinical pathways is one of the most important strategies of "Healthy China 2030" Strategic Plan. Evidence-based assessment and clinical guidelines can provide the best relevant evidence to develop clinical pathways. We planned to analyze the current situation of clinical pathways in China and explore how to apply evidence-based assessment on clinical pathway management. We searched PubMed, EMbase, ISI, CNKI, WanFang Data, VIP and the The Cochrane Library using "critical pathways" and "clinical guidelines" as key words or subject terms. And we conducted a comparison of their published volume, definitions, differences and connections. The management system of clinical pathway in China is fundamentally flawed, it is still a challenge to implement the clinical pathways effectively without scientific methodologies and standardized evidence-based evaluation system. In order to improve the management quality of clinical pathway in China, we should develop clinical pathways based on national situation and innovate the evaluation system to standardize the clinical pathway management according to WHO recommendations of clinical guideline and appraisal.
Due to optimizing medical service resources and improving service efficiency, day surgery has attracted the attention of medical and management experts worldwide. In 2019, day surgery was included as one of the performance assessment indicators of tertiary public hospitals. In recent years, hospital-based day surgery centers have begun to plan and build. Although the basic facilities have been perfectly improved, but how to efficiently and safely operate and manage the centralized day surgery has become the primary problem to clinicians and managers. The purpose of this paper is to introduce how the Day Surgery Center of West China Hospital of Sichuan University uses scientific management tools and establishes a professional multidisciplinary team, so as to carry out efficient operation management and control of medical quality and safety risks of the Day Surgery Center. And then provide practical experience guidance and suggestions with strong feasibility and operability for peers.