子宫肌瘤开腹及腹腔镜手术实施临床路径的方法与体会(1)
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[摘要] 目的 为兄弟医院实施临床路径提供参考方法。方法 ①临床路径流程的设定的方法：标准住院日、住院流程、医嘱、诊疗及护理工作流程、患者版告知单、变异分析等规范设定；②临床路径流程信息管理和执行临床路径实施流程；③效果评价：对平均住院日、待手术日、总费用、总药费、药占比与2009年未实施前数据比较；入径率/规范实施率和路径外药品使用情况进行每月监控比较。结果 平均住院日、待手术日、总费用、总药费、药占比与2009年均有缩短或下降；入径率/规范实施率和路径外药品使用情况不断改进。结论 实施临床路径能缩短住院日、降低总费用、控制药占比，同时能提高团队合作认识、规范环节质控，能达到临床路径管理持续质量改进的目的。
[关键词] 子宫肌瘤；开腹手术；腔镜手术；临床路径；方法与体会
[中图分类号] R737.33 [文献标识码] C [文章编号] 1673-9701(2011)23-126-03
Uterine Fibroids Abdominal and Laparoscopic Surgery in Implementing Clinical Paths and Experience
ZHANG Xuelian WANG Zhiying
Ningbo City Xiangshan County First People's Hospital in Zhejiang Province，Xiangshan 315700，China
[Abstract] Objective To provide a method in hospital clinical path. Methods①clinical path setting method of the process. Includes：standard length of stay，hospital procedures，instructions，diagnosis，treatment and care work processes，inform and mutation analysis in patients with specifications such as set. ②Clinical pathway process information management and implementation of clinical path implementation process.③Evaluation. Today on the average length of stay，pending surgery，total cost，total ratio of drugs，medicine and comparison of 2009 years prior to the implementation of the data；Outside specification implementation rate and path into the rate comparison for monthly monitoring drug use. Results Average hospital day，and to operation day，and total costs，and total medicines，and drug accounted for than and 2009 are has shortened or decline；into by rate/specification implementation rate and path outside drug using situation constantly improved. Conclusion Implementation clinical path can shorten hospital day，and reduce total costs，and control drug accounted for than，while team cooperation，and improve awareness，and specification links mass controlled，can reach clinical path management continu quality improved of purpose.
[Key words] Uterine fibroids；Abdominal surgery；Laparoscopic Surgery；Clinical pathway；Methods and experience
临床路径是由各相关部门及科室的医护人员共同制定的医疗护理服务程序。该程序针对特定的疾病或手术制定出有顺序的、有时间性和最适当的临床服务计划，以加速患者康复，减少资源浪费，使服务对象获得最佳的、持续改进的品质照顾[1]。
临床路径在国际范围风行20多年后，随着我国医疗卫生体制改革的深入发展，在我国的医疗市场与国际接轨的大变革中迅速成长起来。目前，临床路径作为一种新的医疗工作模式已日见普及，并具有确定无疑的前景。我院作为一家县级试点医院，今年3月份在妇科病区开展了子宫平滑肌瘤开腹及腔镜手术两条临床路径 ......
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