Ann Rehabil Med.  2014 Oct;38(5):603-611. 10.5535/arm.2014.38.5.603.

Retrospective Assessment of the Implementation of Critical Pathway in Stroke Patients in a Single University Hospital

• Kim JH
• Byun HY
• Son S
• Lee JH
• Yoon CH
• Lee ES
• Shin H
• Oh MK

• KMID: 2266494
• DOI: http://doi.org/10.5535/arm.2014.38.5.603

Abstract

OBJECTIVE
To evaluate the effects of the implementation of critical pathway (CP) in stroke patients treated at a single university hospital.
METHODS
A retrospective medical review collected data from 497 patients who had suffered acute stroke in the rehabilitation center. Stroke outcomes were compared between before and after the implementation of CP based on factors including demographic factors, stroke characteristics, pre-existing medical conditions, medical complications, functional states, and length of stay (LOS).
RESULTS
After the implementation of CP, the patients showed significantly higher stage for upper proximal (p=0.008) and lower extremity (p=0.001) on Brunnstrom stage and significantly lower scores for modified Rankin Scale (p=0.003) at transfer. For those with pre-existing medical conditions, there were significantly increased osteoarthritis (p=0.002) and valvular heart disease (p=0.011). Regarding medical complications during acute inpatient rehabilitation, there were significantly decreased shoulder pain (p=0.001) and dysphagia (p=0.017), and significantly increased gastrointestinal symptoms (p=0.001). Functional gain and efficiency of stroke patients during rehabilitation center hospitalization did not significantly change after implementation of CP. But, shorter LOS of total hospitalization, pre-rehabilitation center hospitalization, and rehabilitation center hospitalization were evident.
CONCLUSION
After the implementation of CP, patients less often developed complications and displayed no changes in functional gain and efficiency. They had shorter LOS of total hospitalization, pre-rehabilitation center hospitalization and rehabilitation center hospitalization.

Keyword

Stroke; Rehabilitation; Complications; Critical pathways

MeSH Terms

Critical Pathways*
Deglutition Disorders
Demography
Heart Valve Diseases
Hospitalization
Humans
Inpatients
Length of Stay
Lower Extremity
Osteoarthritis
Rehabilitation
Rehabilitation Centers
Retrospective Studies*
Shoulder Pain
Stroke*

Figure

• 

  Fig. 1 Critical pathway of comprehensive rehabilitation (RH) and transfer to Department of Rehabilitation.

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