J Korean Acad Nurs Adm.  2014 Jan;20(1):117-127.

Development and Long Term Evaluation of a Critical Pathway for the Management of Microvascular Decompression

• Lee JA
• Kim JS
• Park K
• Kong DS

Abstract

PURPOSE
In order to provide a systematic and standardized treatment course for MVD patients, a critical pathway (CP) program was developed and the results of its long term application were analyzed.
METHODS
This was a methodological study. The CP was established and applied to 75 (step I) and 1,216 (step II). Another group of 56 with similar features was used as a control group.
RESULTS
The application of CP turned out to be useful in many regards: the rate of hearing loss was reduced from 1.8% to 0% (step I) and 0.5% (step II), and low cranial nerve palsy was reduced from 1.8% to 1.3% and 0.7%, respectively. The length of hospitalization decreased by 2.56 days (25.2%) for step I and 3.05 days (30.0%) for step II. Days of ICU stay were reduced by 7.9% and 1.8%. The total cost per patient was reduced by 14.8% (step I). The cost per day was increased by 13.7% and 52.4%. An increase in the patient satisfaction index was noted, as shown in the ICU information guide (p=.002).
CONCLUSION
The development and application of CP was found to improve the quality of medical treatment and the efficacy of hospital management in MVD patients. Well organized and efficient system and multidisciplinary teamwork are the key component of the successful application of CP.

Keyword

Critical pathway; Microvascular decompression surgery; Quality control; Cost-benefit effectiveness

MeSH Terms

Cranial Nerve Diseases
Critical Pathways*
Hearing Loss
Hospitalization
Humans
Methods
Microvascular Decompression Surgery*
Patient Satisfaction
Quality Control

Figure

• 

  Figure 1 Critical pathway of microvascular decompression. ABGA=Arterial blood gas analysis; A/C & D/B=Active cough & deep breathing; BST=Blood sugar test; CBC=Complete blood count; CT=Computed tomography; D/C=Discontinue; EKG=Electrocardiography; EMG=Electromyography; ENT=Ear, nose and throat; GCS=Glasgow coma scale; GW=General ward; HD=Hospital day; IAC MRI=Internal auditory canal MRI; ICU=Intensive care unit; I/O=Intake/output; iv=Intravenous; L/M=Limb movement; NCS=Nerve conduction study; NPO=Nil per os; N/S=Normal saline (Sodium chloride 0.9%); Op=Operation; opd=Outpatient department; P/S & L/R=Pupil size & Light reflex; PTA/SA=Pure tone audiometry/speech audiometry; SBP=Systolic blood pressure; SOW=Sips of water; SpO2=Pulse oximetry.

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