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JKM > Volume 42(2); 2021 > Article
Kim and Han: Development of a Critical Pathway for a Korean Medicine Hospital Inpatient with Stroke

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.

Fig. 1
Flow chart of the CP development and further plan
CP, critical pathway. Black line: CP development process, gray line: future implementation plan
jkm-42-2-62f1.gif
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)
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)
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)
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)
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)
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)
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)
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)
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)
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
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
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
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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