Trauma Case Management and Clinical Pathways: Prospective Evaluation of Their Effect on Selected Patient Outcomes in Five Key Trauma Conditions

摘要: Background: This study evaluated the implementation of clinical pathways and case management between July 1998 1999 in five key trauma conditions: severe head injury, fractured ribs, pelvis, blunt abdominal trauma, femurs presenting to a single service. Methods: Thirteen elements care with expected outcomes were defined for each condition. Deviations from outcome as variances. Attainment was measured before (stage 1) after introduction (stages 2 3) management. Non-attained quantified categorized into time occurrence, relationship staff, patient, or system. Results: Two hundred thirty-five patients studied, mean age 41.8 (SD, 20.6) years Injury Severity Score (ISS) 11.7 11.0). The number observed variances per patient stage 1 51.7 43.5); 2, 42.3 32.9); 3, 23.2 21.7) (p = 0.0001 both compared 3). There significant improvement achieved (92.7%; 95% confidence interval, 92.5-92.9%), 3 (96.7%; 96.5-96.9%). Of total seen, 0.2% related system errors, 25% factors, 75.8% staff. proportion staff-related significantly reduced 3. Conclusion: Clinical identified areas need remedial action improved delivery our population. It has set template future