自发性气胸外科手术临床路径的变异分析

摘要

目的 分析自发性气胸外科手术临床路径中的变异因素,实施中存在的问题探讨并提出改进措施.方法 2009年10月至2011年3月实行临床路径护理的120例自发性气胸外科手术患者临床护理路径的每日完成情况,统计、分析临床变异情况.结果 临床路径护理120例患者共有92例(76.7％)发生临床变异,所有变异中医护人员引起36次(39.1％),患者需求和医院系统各引起24次(26.1％),疾病转归引起8次(8.7％).按照变异的性质来看,正性变异为20次(21.7％),负性变异为72次(78.3％).对变异影响最大的为术后住院时间(标准化回归系数=0.834).结论 针对自发性气胸外科手术临床路径实施过程中存在变异问题,临床护理路径领导与实施小组需要共同讨论,采取优化措施,充分发挥临床路径的提示、监督、反馈作用.%Objective To analyze the variation factors in clinical pathway,and discuss the problems in clinical pathway variation of surgical operation to spontaneous pneumothorax,as well as provide the solution.Methods 120 patients with spontaneous pneumothorax who underwent surgical operation in clinical nursing pathway were collected between October 2009 and March 2011.Daily performance of clinical nursing pathway was recorded,and statistics and analysis on clinical variation were also performed.Results Clinical variations occurred in 92 patients of 120 patients (76.7％ ),in which 36 were induced by medical care personals (39.1％),24 were separately induced by patients themselves and hospital system (26.1％ ) and 8 were induced by disease prognosis (8.7％).In the all variation,20(21.7％) were positive,and the rest 72(78.3％) were negative.The hospital stays after surgical operation affected variation mostly (the standard regression coefficient was 0.834).Conclusions The leader and the members of clinical pathway group should discuss the clinical pathway variation of surgical operation to spontaneous pneumothorax,and take optimizing action to make clinical pathway give full play of suggestion,superintend and retroaction.