Development of a Critical Pathway for a Korean Medicine Hospital Inpatient with Stroke

Mikyung Kim; Chang-ho Han; Kim, Mikyung; Han, Chang-ho

doi:10.13048/jkm.21015

JKM > Volume 42(2); 2021 > Article

Kim and Han: Development of a Critical Pathway for a Korean Medicine Hospital Inpatient with Stroke

Original Article

The Journal of Korean Medicine 2021; 42(2): 62-71.

Published online: June 01, 2021

DOI: https://doi.org/10.13048/jkm.21015

Development of a Critical Pathway for a Korean Medicine Hospital Inpatient with Stroke

Mikyung Kim¹

, Chang-ho Han²^{, *}

¹Department of Internal Medicine, College of Korean Medicine, Sangji University

²Department of Internal Medicine, College of Korean Medicine, Dongguk University

Correspondence to: Chang-ho Han, Department of Internal Medicine, College of Korean Medicine, Dongguk University 123, Dongdae-ro, Gyeongju, Gyeongsangbuk-do, Republic of Korea, Tel: +82-54-770-1260, Fax: +82-54-770-1500, E-mail: hani@dgu.edu

Received April 15, 2021 Revised May 10, 2021 Accepted May 14, 2021

Abstract

Objectives

This study was aimed to share the development process of the critical pathway (CP) for the treatment and management of stroke patients admitted to a Korean medicine hospital.

Methods

A draft CP was prepared based on a review of relevant literature and medical records in the hospital, and its validity was reviewed by the in-hospital CP review committee. Each member evaluated all items in the CP on a 5-point Likert scale. Items with an average score of 3.5 or higher or an agreement rate of more than 80% were considered valid. In addition, free described opinions to improve the CP were also received from the review committee.

Results

The horizontal axis of the CP was composed of a time domain, including 7 time points from hospitalization to discharge. The vertical axis was composed of 9 domains of medical practice. All items in the CP satisfied the validity criteria. The CP was revised, supplemented, and completed by reflecting the opinions of the committee.

Conclusions

This CP will be taught to in-hospital users and will continue to be used with regular monitoring and a feedback plan. This study is expected to serve as a useful reference for standardizing the treatment process and delivering measures to improve the adequacy of Korean medicine treatment for stroke patients.

Keywords: critical pathway, clinical practice guideline, inpatient, Korean medicine, stroke

Fig. 1

Flow chart of the CP development and further plan

CP, critical pathway. Black line: CP development process, gray line: future implementation plan

Table 1

General Characteristics of In-Hospital Review Committee

Category		Number	Percentage (%)
Gender	Male	5	45
	Female	6	55
	20–29	2	18

Age	30–39	0	0
	40–49	2	18
	50–59	5	46
	60-	2	18

Occupation	Korean medicine doctor	4	36
	Medical doctor	1	9
	Nurse	2	18
	Physical therapist	1	9
	Radiologist	1	9
	Caregiver	1	9
	Health information manager	1	9

Table 2

Distribution of Scores and Consent Rate by Each Domain of the Critical Pathway in Validity Assessment

Domain/Time	Day1 (admission)	Day 2	Day 5	Week 2	Week 4	Week 8*	Discharge
Goals and Outcomes	4.9 (0.06)	4.9 (0.00)	4.9 (0.00)	5.0 (0.00)	4.9 (0.00)	4.9 (0.00)	4.9 (0.00)
Goals and Outcomes	100 (0.0)	100 (0.0)	100 (0.0)	100 (0.0)	100 (0.0)	100 (0.0)	100 (0.0)

Diagnostic test	5.0 (0.04)	4.5 (0.06)	5.0 (0.06)	4.7 (0.21)	4.9 (0.00)	5.0 (0.00)	4.6 (0.27)
Diagnostic test	100 (0.0)	91 (4.9)	100 (0.0)	94 (5.2)	100 (0.0)	100 (0.0)	91 (10.0)

Assessment	4.9 (0.04)	4.9 (0.03)	4.7 (0.12)	4.9 (0.16)	4.7 (0.19)	4.9 (0.08)	4.9 (0.10)
Assessment	99 (2.3)	99 (3.2)	98 (4.1)	97 (5.7)	98 (5.4)	99 (2.5)	97 (4.4)

Medication and Treatment	4.8 (0.19)	4.8 (0.15)	4.8 (0.20)	4.8 (0.10)	4.9 (0.08)	4.9 (0.07)	4.9 (0.08)
Medication and Treatment	97 (5.9)	99 (3.4)	97 (5.9)	95 (4.7)	96 (4.7)	96 (4.7)	96 (4.7)

Activity	4.4 (0.61)	4.6 (0.19)	4.7 (0.28)	4.7 (0.06)	4.6 (0.39)	4.7 (0.32)	4.7 (0.32)
Activity	85 (18.9)	91 (0.0)	94 (5.2)	95 (6.4)	91 (12.9)	95 (6.4)	95 (6.4)

Nutrition	4.6 (0.25)	4.6 (0.27)	4.6 (0.29)	4.6 (0.34)	4.5 (0.26)	4.7 (0.25)	4.6 (0.27)
Nutrition	91 (7.4)	92 (6.8)	91 (8.1)	91 (8.1)	89 (6.8)	94 (6.9)	92 (8.2)

Education for patients and family	4.8 (0.11)	4.7 (0.14)	4.7 (0.10)	4.8 (0.09)	4.8 (0.08)	4.8 (0.06)	4.9 (0.05)
Education for patients and family	97 (4.9)	96 (5.0)	98 (4.1)	98 (4.1)	98 (4.1)	100 (0.0)	100 (0.0)

Consult or cooperation with other department or hospitals	4.7 (0.26)	4.8 (0.19)	4.7 (0.15)	4.8 (0.09)	4.9 (0.17)	4.9 (0.14)	4.9 (0.17)
Consult or cooperation with other department or hospitals	91 (7.4)	93 (4.5)	93 (4.5)	95 (5.2)	95 (5.2)	95 (5.2)	95 (5.2)

Exceptional circumstances	4.5 (0.28)	4.6 (0.10)	4.6 (0.09)	4.5 (0.10)	4.5 (0.09)	4.5 (0.09)	4.6 (0.10)
Exceptional circumstances	85 (5.2)	88 (5.2)	91 (0.0)	88 (5.2)	88 (5.2)	88 (5.2)	88 (5.2)

* The critical pathway will be applied every 4 weeks from the week 8.

Upper row: mean (standard deviation)

Bottom line: percentage agreement (standard deviation)

Table 3

Free-answer Description for Critical Pathway Modification

Domain	Classification	Contents	Reflected or not
Diagnostic test	Clinical tests in Korean medicine	Regularization of test	Reflected
		Addition of test item (live blood test)	Reflected
		Addition of test frequency (more than 3 times)	Not reflected
Assessment	Checking the history of heart disease		Reflected
	Risk assessment of major nonsocomial infection		Partially reflected
	Assessment of respiratory function		Reflected
	Regular assessment of swallowing, urination, and bowel function		Reflected
	Evaluation of whether inserted tubes or cannulas can be removed		Reflected
	Cognitive function assessment	Regularization at hospitalization	Reflected
	Cognitive function assessment	Executed at hospitalization, but not required during hospitalization. Consider pre-discharge assessment, if necessary	Reflected
	Dementia assessment	Regularization at hospitalization	Not reflected
	Dizziness assessment	Regularization at hospitalization	Not reflected
	Assessment of rehabilitation therapy availability	Consider from the day of admission	Reflected
Medication and Treatment	Addition of therapy	Taping, arm sling	Reflected
Medication and Treatment	Terminology change	Routine herbal medication -> Herbal medication with pattern identification	Reflected
Education for patients and family	Exercise training during hospitalization	Addition of individual education of daily life movement training and physical exercise	Reflected
	Pre-discharge education	Addition of fall prevention training	Reflected
	Exercise training during hospitalization	Addition of self-medication administration	Reflected
Etc.	Need for separated pathways	Separate application of CPs is required between acute and sequelae stage	Not reflected
Etc.	Need to comply with principle of diagnostic coding	The order of inputting the main and sub diagnosis codes and coding principles needs to be complied	Not reflected

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