冠狀動脈繞道手術臨床路徑之建立與成效評值

The Development and Evaluation of the Clinical Pathway of Coronary Artery Bypass Grafting Surgery

本研究目的在建立冠狀動脈繞道手術臨床路徑，了解臨床路徑實施後對冠狀動脈繞道手術患者其手術後住加護單位天數、手術後住院天數、自加護中心轉出48小時再入院率、出院後14天再入院率、住院費用及住院服務滿意度之影響。研究設計為描述及比較性研究，以立意取樣收集某醫學中心施行臨床路徑前之冠狀動脈繞道手術病患共128位，臨床路徑後之冠狀動脈繞道手術病患共88位。研究發現：（1）臨床路徑施行後之手術後加護中心天數由6.2天降至4天；平均住院天數由2.4天降至19.6天。（2）自加護中心轉出48小時再入院率1.1%；出院14天再入院率3.4%；6.25%冠狀動脈繞道手術患者超出預定住院天數以病患病情需要而致的變異最多。（3）臨床路徑實施後之冠狀動脈繞道手術患者在住院費用及服務滿意度與實施前並無顯著差異。本研究建議臨床路徑的評估應該持續進行，本研究進行過程中發展出之路徑時間表及研究結果，在不影響病患之照護品質，變更原來之作業流程，不但可以提升醫護工作人員的工作效率，同時並保障病患安全與權益。

The purpose of this study was to understand the effects of coronary artery bypass graft (CABG) surgery with clinical pathway on patients' length of intensive care unit (ICU) stay, length of surgical stay, readmission rate 48 hours after transfer out of ICU, readmission rate 14 days after discharge, cost of hospitalization, and satisfaction scores. The study used a comparative descriptive design and methods. 128 subjects who underwent CABG surgery without clinical pathway and 88 subjects who underwent CABG with clinical pathway at medical centers in Taipei were enrolled by purposive sampling. The study results indicated: (1) patients of CABG surgery with clinical pathway exhibited marked decrease in length of ICU stay from 6.2 to 4 days and in average days of hopitalization from 22.4 to 19.6; (2) the readmission rate 48 hours after transfer out of ICU was 1.1%; the readmission rate 14 days after discharge was 3.4%; 62.5% of the 88 CABG surgery patients' had a post-operative hospital stay longer than the scheduled number of days, the most common reason being due to the needs of the patient's condition; (3) there was no significant difference in the cost of hospitalization and satisfaction scores of CABG surgery patients with and without clinical pathway. The authors suggest that clinical pathway evaluation of CABG patients should be conducted periodically, and that revising CABG clinical pathway time schedules based on the study results can promote the efficiency of medical teams, and protect the safety and rights of patients.