Jin Hoan Kim1, Ha Young Byun1, Seungnam Son2, Joong Hoon Lee1, Chul Ho Yoon1, Eun Shin Lee1, Heesuk Shin1, Min-Kyun Oh1. 1. Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea. ; Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea. 2. Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea. ; Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea.
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.
OBJECTIVE: To evaluate the effects of the implementation of critical pathway (CP) in strokepatients 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 strokepatients 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.
Authors: D Sorbello; H M Dewey; L Churilov; A G Thrift; J M Collier; G Donnan; J Bernhardt Journal: Cerebrovasc Dis Date: 2009-07-30 Impact factor: 2.762
Authors: Amilcar Espinosa-Aguilar; Hortensia Reyes-Morales; Carlos E Huerta-Posada; Itzcoatl Limón-Pérez de León; Fernando López-López; Margarita Mejía-Hernández; María A Mondragón-Martínez; Ligia M Calderón-Téllez; Rosa L Amezcua-Cuevas; Jorge A Rebollar-González Journal: J Trauma Date: 2008-05