혈액투석 환자를 위한 Critical Pathway 개발

Development of the Critical Pathway for New Chronic Renal Failure PatientOnitiation of Dilysis

Recently operating costs at many hospitals are changing. We should research how to increase medical services and at the same time, whether medical fee can be decreased. The purpose of this study was to develop a critical pathway for patients undergoing chronic renal failure(Initiation of Hemodialysis), which aims to standardize and systematize the patient care in initiation of hemodialysis The first step of developing the critical pathway was to select the disease/ treatment modality which was initiation of hemodialysis in this study. In the second step, a development team consisted of eight experts who were working and studing in hemodialysis area. In the third step, the service content and the implementation period for the hemodialysis was decided by reviewing medical records. In the forth step, a preliminary critical pathway was made through verification of expert group on content validity. In the fifth step, the clinical appropriateness of the preliminary critical pathway was validated by applying it to new three patients undergoing initiation of hemodialysis. In the sixth step, the final critical pathway was developed. Through the process the following results were obtained: 1. Nine categories of medical services, test, diet/nutrition, medication, activity/safety, consult, monitoring/assessment, treatment/care, education and discharge plan were set to vertical axis, and the hospital stay from hospital admission to discharge was set to the horizontal axis. 2. The mean hospital stay (from hospital admission to hemodialysis) of 20 patients reviewed was 3 days, and the overall hospital stay (from hospital admission to discharge) was 14.4days. 3. Among 94 items on medical service contents in 9 categories, 81 items showed expert s agreement over 88% and were selected to analyze. Thirteen items were modified because of showing expert’s agreement below 75%. 4. A clinical validity test was done in three patients. Five patients were selected for clinical validity test but two patients were attrited. A preliminary critical pathway was validated using remaining three patients. The mean hospital stay of them was 9.6 days. Seven items showed differences between preliminary critical pathway and the real medical activities. Those seven items was modified or supplemented, one was deleted, and six were added to make the final critical pathway.