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Original Article

Reduction of Length of Stay in Emergency Room by Using Critical Pathway for Stroke Patients

Yeo Ok Yun1, Min Young Kim2, Woo Jeong Kim3, Young Joon Kang3, Ju Ok Park3, Kyung Hye Park4
Journal of Korean Academy of Nursing Administration 2011;17(1):66-73.
Published online: March 31, 2011

1Nurse Manager, Emergency Medical Center, Jeju National University Hospital, Korea.

2Instructor, College of Nursing, Jeju National University, Korea.

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Correspondence: Kim, Min Young. Instructor, College of Nursing, Jeju National University 1, Ara 1dong, Jeju city, Jeju Special Self-Governing Province, 690-756, Korea. Tel: 82-64-754-3750, Fax: 82-64-702-2686, musemy2@hanmail.net
• Received: November 12, 2010   • Revised: January 18, 2011   • Accepted: January 18, 2011

Copyright © 2011 Korean Academy of Nursing Administration

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  • Purpose
    The purpose of this study was to demonstrate effects of a critical pathway (CP) for stroke patients seen in emergency rooms (ER).
  • Methods
    The CP developed by the CP committee consisted of 8 criteria: behavior of doctors and nurses, laboratory tests, Image testing, medication, treatment, activity, and nutrition. According to application of CP, a control group (n=17) and experimental group (n=17) were defined. Time was checked by the electronic medical records.
  • Results
    Use of CP for stroke patients in the ER, resulted in a decreased length of stay in ER (t=2.341, p=.026), and time required for image testing (t=2.623, p=.021), and an increased number of patients using rtPA (χ2=4.802, p=.049). Time required for neurology doctor contact, for neurology doctor to see patient in the ER, and for report of blood tests decreased, but there were no statistical significance.
  • Conclusion
    Quick responses are most important in the ER, so CP for these patients is a very effective patient management tool. To reduce delay in stroke diagnosis, continuous education programs for similar symptoms are necessary. CPs for other patients in the ER should be developed, and studies on cost and satisfaction, as well as length of stay, should be done.
  • Key Words: Critical pathways; Length of stay; Stroke; Emergency service
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  • 3. Hong YM. Developing activity based clinical pathway for patients with total hip replacement. J Korean Acad Nurs Adm. 2002;8(4):669-689.
  • 4. Kim EO. Effects of a standardized critical pathway in gastrectomy patients. 2004;Seoul, Seoul National University. Unpublished doctoral dissertation.
  • 5. Kim GY. Development of a critical pathway for patients with coronary artery bypass graft. J Korean Acad Nurs. 1998;28(1):117-131.
  • 6. Kim JJ, Kim NC, Kim MJ, Kim OS, Kim YS, et al. Medical Surgical Nursing. 2005;Seoul, Hyunmoon publishing.
  • 7. Kim JS. Development of a critical pathway of barbiturate coma therapy in the management for severe brain damage. J Korean Acad Nurs Adm. 2010;16(1):59-72.
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Table 1
Schedule for this study
jkana-17-66-i001.jpg

C: control group, CP: critical pathway, E: experimental group

Table 2
Checklist for this study
jkana-17-66-i002.jpg

Exam: examination, ED: emergency department, Dr.: doctor, NR: neurology, ER: emergency room,

CBC: complete blood count, CHE: chemistry, e: eloctrolyte, Coa: coagulation

Table 3
Critical pathway for acute stroke patients in emergency room
jkana-17-66-i003.jpg

ED: emergency department, FAT: first abnormal time LNT: last normal time, BP: blood pressure, MRI: magnetic resonance imaging,

rtPA: recombinant tissue plasminogen activator, NR: neurology, NIHSS: National Institute of Health Stroke Scale,

MSE: Mental Status Examination, CNE: cranial nerve examination, DWI: derfusion-weighted imaging, PWI: perfusion-weighted imaging,

SU: stroke unit, PCT: pre-enhanced computed tomography, IV: intravenous, NPO: nothing by mouth

Table 4
Cross-tabulation of this study (n=32)
jkana-17-66-i004.jpg
Table 5
Effects of critical pathway for acute stroke patients
jkana-17-66-i005.jpg

Exam: examination, EM: emergency medicine, Dr.: doctor, NR: neurology, ER: emergency room,

CHE: chemistry, e: eloctrolyte, Coa: coagulation, rtPA: recombinant tissue plasminogen activator

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Factors affecting the length of stay in the emergency department for critically Ill patients transferred to regional emergency medical center
      Hyungbok Lee, Sangrim Lee, Hyeoneui Kim
      Nursing Open.2023; 10(5): 3220.     CrossRef
    • Development of a Critical Pathway for a Korean Medicine Hospital Inpatient with Stroke
      Mikyung Kim, Chang-ho Han
      Journal of Korean Medicine.2021; 42(2): 62.     CrossRef

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    Reduction of Length of Stay in Emergency Room by Using Critical Pathway for Stroke Patients
    J Korean Acad Nurs Adm. 2011;17(1):66-73.   Published online March 31, 2011
    DOI: https://doi.org/10.11111/jkana.2011.17.1.66
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    Reduction of Length of Stay in Emergency Room by Using Critical Pathway for Stroke Patients
    J Korean Acad Nurs Adm. 2011;17(1):66-73.   Published online March 31, 2011
    DOI: https://doi.org/10.11111/jkana.2011.17.1.66
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    Reduction of Length of Stay in Emergency Room by Using Critical Pathway for Stroke Patients
    Reduction of Length of Stay in Emergency Room by Using Critical Pathway for Stroke Patients

    Schedule for this study

    C: control group, CP: critical pathway, E: experimental group

    Checklist for this study

    Exam: examination, ED: emergency department, Dr.: doctor, NR: neurology, ER: emergency room,

    CBC: complete blood count, CHE: chemistry, e: eloctrolyte, Coa: coagulation

    Critical pathway for acute stroke patients in emergency room

    ED: emergency department, FAT: first abnormal time LNT: last normal time, BP: blood pressure, MRI: magnetic resonance imaging,

    rtPA: recombinant tissue plasminogen activator, NR: neurology, NIHSS: National Institute of Health Stroke Scale,

    MSE: Mental Status Examination, CNE: cranial nerve examination, DWI: derfusion-weighted imaging, PWI: perfusion-weighted imaging,

    SU: stroke unit, PCT: pre-enhanced computed tomography, IV: intravenous, NPO: nothing by mouth

    Cross-tabulation of this study (n=32)

    Effects of critical pathway for acute stroke patients

    Exam: examination, EM: emergency medicine, Dr.: doctor, NR: neurology, ER: emergency room,

    CHE: chemistry, e: eloctrolyte, Coa: coagulation, rtPA: recombinant tissue plasminogen activator
    Table 1 Schedule for this study

    C: control group, CP: critical pathway, E: experimental group

    Table 2 Checklist for this study

    Exam: examination, ED: emergency department, Dr.: doctor, NR: neurology, ER: emergency room,

    CBC: complete blood count, CHE: chemistry, e: eloctrolyte, Coa: coagulation

    Table 3 Critical pathway for acute stroke patients in emergency room

    ED: emergency department, FAT: first abnormal time LNT: last normal time, BP: blood pressure, MRI: magnetic resonance imaging,

    rtPA: recombinant tissue plasminogen activator, NR: neurology, NIHSS: National Institute of Health Stroke Scale,

    MSE: Mental Status Examination, CNE: cranial nerve examination, DWI: derfusion-weighted imaging, PWI: perfusion-weighted imaging,

    SU: stroke unit, PCT: pre-enhanced computed tomography, IV: intravenous, NPO: nothing by mouth

    Table 4 Cross-tabulation of this study (n=32)

    Table 5 Effects of critical pathway for acute stroke patients

    Exam: examination, EM: emergency medicine, Dr.: doctor, NR: neurology, ER: emergency room,

    CHE: chemistry, e: eloctrolyte, Coa: coagulation, rtPA: recombinant tissue plasminogen activator

    Table 1

    Table 2

    Table 3

    Table 4

    Table 5

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