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.
ObjectiveTo understand the current situation in the treatment of hepatic echinococcosis. MethodThe literatures about operation treatment, drug treatment, and the clinical pathway of hepatic echinococcosis were reviewed. ResultsCurrently, with the continuous development of surgical techniques and the application of minimally invasive surgery, the operative treatments of hepatic echinococcosis had made a great progress, it was still the preferred treatment for the disease. Liver transplantation was made as the final choice. The use of aspiration, sclerotherapy or interventional technique brought a hope for patients intolerant to laparotomy. Moreover, chemotherapy drugs, Chinese herbal medicine, and drug combinations also achieved a very good effect in the treatment of hepatic echinococcosis. The clinical pathway provided a good direction for the treatment of hepatic echinococcosis. ConclusionFor the treatment of hepatic echinococcosis various, we should choice a reasonable treatment according to the specific circumstances of patients, to achieve the best therapeutic effect with minimal trauma.
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.
ObjectiveTo explore the application of clinical pathway in patients undergoing orthopedic day surgery.MethodsPatients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2020 were selected as the clinical pathway group, and all of them were managed by clinical pathway. Patients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2019 were selected as the routine group, and all of them were managed by conventional clinical methods. The general conditions of patients, physicians’ work efficiency, medical costs and medical quality were compared between the two groups.ResultsThe clinical pathway group included 246 patients, and the routine group included 391 patients. There was no significant difference in gender, age or disease distribution between the two groups (P>0.05). Compared with the routine group, the clinical pathway group had obvious advantages in terms of average time spent by a physician in issuing a medical order each time [(5.64±3.29) vs. (2.12±1.05) min], average number of revisions per physician’s order (1.40±0.24 vs. 0.38±0.19), rate of filing medical records within 3 days (90.28% vs. 97.97%), hospital costs [(7462.10±1035.01) vs. (6252.52±1189.05) yuan], drug costs [(652.21±88.53) vs. (437.17±108.20) yuan], length of stay [(1.23±1.04) vs. (1.02±0.18) d] and delayed discharge rate (7.93% vs. 2.03%), with statistically significant differences (P<0.05). There was no significant difference between the two groups in terms of unplanned reoperation rate, unplanned rehospitalization rate, or patient satisfaction (P>0.05).ConclusionCompared with routine clinical management, clinical pathway management can improve work efficiency, reduce medical cost and improve medical quality more effectively in the implementation of orthopedic day surgery, which has very positive effects and is worthy of promotion and application.
Objective To investigate the efficacy of improved clinical nursing path for day surgery of laparoscopic cholecystectomy (LC). Methods The clinical data of 3 274 patients who underwent day surgery of LC following the clinical pathway between January 2011 and December 2015 were collected. The rate of adverse events including pain, postoperative nausea and vomiting (PONV), retention of urine and staxis before and after the improvement of clinical nursing path was analyzed and compared. Results For adverse event rate before and after the improvement of clinical nursing path, the difference in the incidence of pain and PONV was statistically significant (P < 0.05), while the difference in retention of urine and staxis was not statistically significant (P > 0.05). Conclusions Through the improvement of clinical nursing path for LC during day time, the procedure of nursing becomes more standardized. It is more feasible for clinical work and postoperative adverse reactio n rate becomes lower. It can also help shorten postoperative rehabilitation time and ensure perioperative medical quality and safety.
ObjectivesTo investigate sources of evidence of the clinical pathways approved by the Chinese government.MethodsThe approved clinical pathways were obtained from the website of the National Health and Family Planning Commission. Two reviewers independently extracted the basic information, approval date, types of evidence of the clinical pathways and time of evidence. The variance analysis was performed for the diagnosis and treatment parts of clinical pathways and the LSD method was further used for comparison.ResultsThe main types of evidence were guidelines, textbooks, standard indicators and consensus views. Approximately 80% of the pathways cited clinical practice guidelines and 36% cited the textbooks. The median number of evidence for each clinical pathway was 2. Approximately 85% of the evidence could be obtained the time when the evidence published. The average time interval (between the time when the pathways released and the time when the evidence published) was 5.2 years. Specifically, textbooks constituted the largest proportion in all evidence that was over 15 years of time interval. In addition to the textbook comparison standard indicators, there were significant differences in time interval between guidelines or consensus and textbooks or standard indicators.Conclusions The evidence types selection is based on the concept of evidence-based medicine, yet the time span of the referred evidence is larger. Therefore, developing clinical pathways not only need to refer to the latest research evidence comprehensively and enhance transparency of clinical pathways, but also use evidence quality evaluation standards to evaluate and select the referred evidences.
Exercise prescription is an effective tool for the prevention and control of hypertension, diabetes and dyslipidemia. However, a full set of exercise prescription is difficult to be implemented in China's primary medical institutions and community public health service centers. Therefore, under the support of the theoretical system of exercise prescription and the standard development norms, this clinical pathway of exercise prescription is developed according to the characteristics of national physical fitness and the status quo of primary healthcare institutions in China, aiming at simplifying the process of exercise prescription development, reducing the professional threshold, empowering primary healthcare, and providing a scientific and feasible solution for the promotion of exercise prescription in primary healthcare institutions.
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.
Objective To evaluate the feasibility of the clinical pathway based on the medical data information integration system to guide the treatment of palmar hyperhidrosis (PHH). Methods We retrospectively analyzed the clinical data of 106 PHH patients in the Fourth Affiliated Hospital of Harbin Medical University from March 2012 through June 2015. The patients were divided into two groups including a day surgery group (52 patients) and a traditional group (54 patients). The patients in the day surgery group underwent day surgery guided by clinical pathway of PHH based on medical data information integration system. The patients in the traditional group stayed in hospital for 2-3 days. The pre-surgical situation, post-surgical effect of patients and cost of hospitalization were compared between the two groups. Results Only one patient of PPH suffered from insufficient relief of symptoms. The other patients’ symptom of PPH disappeared. No serious complication occurred. The postoperative visual analogue scale (VAS) pain score of patients was lower than 2 points. The hospitalization expense of the day surgery group was significantly lower than that of the traditional operation group. The average follow-up time was 2.5 months (0.5 to 4 months). The symptoms of the whole group had no recurrence. All of the patients were not found with compensatory hyperhidrosis. Conclusion Day-surgery clinical pathway of PHH based on medical data information integration system is safe and feasible. Day-surgery clinical pathway of PPH can accelerate the recovery of patients and save the cost of hospitalization.
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.