Development of a Critical Pathway for the Patients following Lumbar Laminectomy

Kim, So Sun; Roh, Young Sook

Abstract

The purpose of this study was to develop a critical pathway for the patients following lumbar laminectomy. Development of this critical pathway was the fundamental phase to implement case management, which is a new health care delivery system. For this study, a preliminary critical pathway was developed first through a literature review and analysis of the medical records and seven critical pathways being used currently in Korea and the USA. In order to identify the health care services provided for the patients, who had lumbar laminectomiess and to draw up the conceptual framework, 30 medical records were analyzed from January, 1997 to December, 1997 at the Spinal Center in the Yonsei University Medical Center. The results of this study are as follows: 1. The vertical axis of the critical pathway included the following 7 items: test, assessment, treatment, activity, medication, diet, teaching and discharge planning; and the horizontal axis included the time frame from the pre-operative day to the third post-operative day. 2. Analysis of the 30 medical records indicated that the average length of stay was 13.7 days, including 4.8 days from admission to operation, and 8.9 days from operation to discharge. 3. According to the validity study using seven experts, 54 items, among the total of 86 items, reached over 86% agreement, while 32 items showed less than 86%. These 32 items were reviewed for deletion or modification before inclusion. A final critical pathway then was developed. On the basis of this research, it is anticipated that this critical pathway can be uesd in clinical situations to provide care for the patients following lumbar laminectomy in the most effective and efficient manner.