当院におけるTUR-Pオールインワンパスの活用

Abstract

当院のTransurethral resection of prostateに導入した医療者用, 患者用オールインワンパス(以後パス)の効果について検討した.泌尿器科におけるパス導入直前の連続27例, 導入直後の連続29例, 導入1年後の連続30例を対象とした.その結果, 術当日を含む尿道カテーテル留置期間は, パス導入後でも2～7日と幅があり3群間に有意差はなかったが, カテーテル抜去の基準は, 淡々血尿となった術後3～4日という認識が浸透し, 平均値が4日に近づいた.点滴抗生剤投与日数は2日と短縮し, 経口抗菌剤投与症例数は, パス導入前ではほぼ全例に施行していたが, 導入後減少し導入1年後では全く施行しなくなった.術後合併症の増加はなく, 入院期間は導入後に有意に短縮した.保険請求点数については, パス導入後多少減額していたが有意差を認めなかった.パス導入後のバリアンスにおいて, 導入直後に比べて導入1年後では, 術前検査忘れや追加検査は減少した.オールインワンパスは, 医療業務の効率化, 医療安全管理対策, インフォームドコンセントの充実化につながると考えられた

We evaluated the usefulness of our original all-in-one clinical pathway for transurethral resection of the prostate (TUR-P) on 86 consecutive patients. There were 27 consecutive patients treated before introduction of the clinical pathway (group 1). Twenty-nine consecutive patients were treated just after the introduction of the clinical pathway (group 2) and 30 consecutive patients were treated one year after the introduction of the clinical pathway (group 3). Our pathway includes all items such as vital sign charts and events charts. Although the hospitalization ranged from 5 days to 12 days after introduction of the clinical pathway, the average length of hospital stay was shortened by 2.6 days in group 3. Although the duration of the postoperative indwelling urethral catheter ranged from 2 days to 7 days in the groups 2 and 3, the average duration was approximately 4 days in group 3. Postoperative complications did not differ among the three groups. The medical insurance claims decreased with the introduction of the clinical pathway. Our all-in-one clinical pathway is considered to be a good tool for not only reduction of health care costs but also giving higher quality and better service to patients.