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目的通过对临床路径管理模式的学习,分析输尿管结石实施临床路径的变异原因。方法按照卫生部单病种临床路径管理模式对126例输尿管结石实施临床路径,手术方式为输尿管硬镜弹道碎石术。路径模式为:住院第1~2天为术前各项准备工作日,第3天为手术日,第4~5天为术后治疗日,第6~7天为安排出院日。结果输尿管结石临床路径实施过程中的变异因素主要有三类:系统变异、医务人员变异及患者因素变异。三种变异因素可相互交错存在。主要变异因素为患者解剖结构异常导致的系统变异,这种变异因素具有不可预知性,成为决定路径能否顺利实施的关键。其次为患者因素变异,表现为患者对临床路径治疗模式的不理解以及结石合并其他疾病等。最后为医务人员因素,包括向患者解释临床路径的态度及方式、手术操作熟练程度等。结论对系统变异、医务人员变异及患者因素变异提出相应的改进措施,为将来更好地实施临床路径提供经验。
Objective To study the causes of the variation of clinical path of ureteral calculi through the study of clinical path management mode. Methods According to the clinical path management model of single disease of the Ministry of Health, 126 cases of ureteral calculi were performed clinical pathways, and the operation mode was ureteroscopic ballistic lithotripsy. The path patterns are as follows: hospitalization days 1 to 2 are preoperative preparatory work days, day 3 is operation day, days 4 to 5 are postoperative treatment days, and days 6 to 7 are discharge days. Results There are three main variation factors in the clinical path of ureteral calculi: variation of system, variation of medical staff and variation of patient factors. Three variations can be staggered with each other. The main variation is the systematic variation caused by the abnormality of the patient’s anatomy. The variation factor is unpredictable and becomes the key to decide whether the path can be successfully implemented. Followed by variation in patient factors, manifested as patients do not understand the clinical pathological treatment of stones and other diseases combined with other diseases. Finally, the medical staff factors, including the patient’s clinical path to explain the attitude and manner, surgical proficiency and so on. Conclusions The corresponding measures for improvement of system variation, medical staff variation and patient factor variation are proposed to provide experience for better implementation of clinical pathology in the future.