摘要目的 研究利用自制"分轨路径"电子医嘱模板对小儿肠套叠和阑尾炎两病种实施临床路径管理的可行性与价值.方法 课题组基于路径节点概念,利用传统路径管理程序的医嘱包功能编制出一种带若干强变异处理分支的"分轨路径"医嘱模板. 2018年2月至2019年1月在泰安市中心医院诊断肠套叠和阑尾炎的患儿按入院次序的奇偶分配接受分轨路径或传统单轨路径的管理.结果 436例诊断肠套叠和624例阑尾炎的患儿接受了分配管理.排除部分误诊、自动出院和失访患儿后,肠套叠和阑尾炎病种分别有216例和302例纳入使用分轨路径的观察组, 210例和310例纳入使用传统路径的对照组,观察组和对照组病例基本资料与治疗方法比较差异均无统计学意义(P>0.05).观察组肠套叠和阑尾炎病种的路径实际完成率为97.2% (210/216)和97.7% (295/302),高于对照组的90.5% (190/210)和91.3% (283/310);路径外医嘱率为(4.6 ± 1.3)%和(6.1 ± 1.7)% ,低于对照组的(19.3 ± 5.2)%和(20.3 ± 5.1)% ;住院时间是(2.7 ± 0.3)天和(5.6 ± 0.4)天,低于对照组的(3.2 ± 0.4)天和(6.2 ± 0.5)天;住院费用低于对照组,满意率高于对照组;以上指标组间比较差异均有统计学意义(P<0.05).结论 分轨路径属于复合型路径的一种,适用于病情或诊疗强变异较多的孤立性疾病,相比传统路径能有效处理强变异,提高路径执行质量.

abstractsObjective To evaluate the feasibility and efficacy of a self-made arborizing clinical pathway( ACP ) in acute pediatric intussusceptions and appendicitis. Methods Based on the clinical pathway(CP)-node concept, an ACP electronic template with some CP branches for dealing with significant variations was made, using a doctor-advices package in the CP program of the Clinical Information System in our hospital. From February 2018 through January 2019, children inpatients diagnosed with acute intussusceptions at our hospital accepted the ACP or the conventional CP management respectively according to parity of admitted order. Results 426 children diagnosed with intussusceptions and 612 children diagnosed with appendicitis were included. After excluding some unqualified samples, 216 intussusception and 302 appendicitis children were enrolled in the observation group respectively which was subject to the ACP, 210 and 310 in the control group subject to the conventional CP. There were no significant differences between the observation and control groups in both diseases about patient demographics and therapeutic approach. The CP implementation-quality differences between the two groups in both diseases were observed and compared. Significant differences were found between the two groups in both diseases about CP completion rate(97.2% versus 90.5% and 97.7% versus 90.1% ), the rate of outside-CP doctor′s orders ((4.6 ± 1.3)% versus (19.3 ± 5.3)% and ( 6.1 ± 1.7 )% versus (20.3 ± 5.1 )% ), the hospitalized period((2.7 ± 0.3)d versus (3.2 ± 0.4)d and(5.6 ± 0.4) d versus (6.2 ± 0.5) d), the hospitalization costs and the satisfaction rate.Conclusions ACP belongs to one of compound CPs, is appropriate to use in these solitary diseases with significant variations. ACP can deal with the CP problem of significant variations rooted in the diseases or treatments, thus contributing to promotion and application of CP.