根治的恥骨後式前立腺全摘除術クリニカルパス導入の検討

Abstract

熱型表, 医師記録, 看護記録を一体化したオールインワン型クリニカルパスを作成し, 導入前後を比較検討した。2003年8月～2004年12月に恥骨後式前立腺全摘除術を施行した33例(56～77歳)のパス前と2005年1月～10月の27例(54～77歳)のパス後を対象に行った。パス導入後に早期歩行開始, 早期食事開始, 点滴施行期間の短縮, 点滴抗生剤投与期間の短縮の達成ができ, 術後在院日数が2.1日の短縮が可能となり, 診療点数も平均9417点と有意に削減できた。パス導入後のバリアンス評価では退院を延期されるものとして尿道カテーテル抜去関連が7例と最多であり, 今後のパス設定は8～11日が適当と考えられた。看護師アンケート調査からも患者把握やカルテ記載の改善を認める結果が得られた。

The efficacy of an all-in-one clinical pathway for retropubic radical prostatectomy (RRP) was assessed. A total of 60 patients were enrolled, including 33 before the introduction of the pathway (mean age 67.3) and 27 after the introduction (mean age 66.4). The introduction of the pathway significantly improved recovery after the surgery, such as time of ambulant (mean postoperative day 1.5 vs 1.1), food intake (1.3 vs 1.0) and duration of intravenous fluid administration (3.1 vs 2.5). The mean postoperative hospital stay was shortened by 2.1 days (p = 0.06). Medical fees decreased by yen 94170 (p < 0.05). The variance related to the removal of a urethral catheter was observed in seven cases. The catheters were indwelled 3-7 days longer. According to the questionnaire survey, 80% of nurses had good impression on the path because the introduction of the path resulted in improving patient assessment, volume of nurse records, simplicity of the overall description and handling nurse records. The RRP clinical pathway is useful to achieve early recovery, short hospital stay and cost reduction.