Actual situations involving the use of clinical pathways for cerebral infarction in acute care wards and early rehabilitation by nurses: A cross-sectional survey across Japan

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  • Tamane Sachie
    Nursing Department, Medical Hospital of Tokyo Medical and Dental University
  • Igarashi Ayumi
    Graduate School of Medicine, The University of Tokyo
  • Ogata Yasuko
    Graduate School of Health Care Sciences, Tokyo Medical and Dental University
  • Okamoto Yuko
    Faculty of Nursing, Japanese Red Cross College of Nursing
  • Yamamoto Munetaka
    Graduate School of Medicine, Juntendo University nursing care

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Other Title
  • 脳卒中急性期病棟における脳梗塞クリニカルパスの使用状況と早期離床に関わる看護ケアの実態
  • 平成24年度学術研究助成 脳卒中急性期病棟における脳梗塞クリニカルパスの使用状況と早期離床に関わる看護ケアの実態
  • ヘイセイ 24ネンド ガクジュツ ケンキュウ ジョセイ ノウソッチュウ キュウセイキ ビョウトウ ニ オケル ノウ コウソク クリニカルパス ノ シヨウ ジョウキョウ ト ソウキ リショウ ニ カカワル カンゴ ケア ノ ジッタイ

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Abstract

<p>Aim: The aim of this study was to clarify the use of clinical pathways of cerebral infarction in the acute stage (acute-care pathways) and those for regional cooperation (liaison pathways) in acute care wards all over Japan. It also aimed to demonstrate, through investigations of acute-care pathways, the content of the care in order to clarify the current status of early rising care of cerebral infarction patients.</p><p>Methods: We randomly selected 50% of all hospitals providing medical treatment for cerebral infarction in Japan. For the 1,601 selected hospitals, we conducted a self-rated questionnaire survey for the use of acute-care pathways and liaison pathways. We examined the associations between three groups in the use of pathways and characteristics of hospitals and wards. Further, we created and examined a list of care items for early rising, as demonstrated in the acute-care pathways.</p><p>Results: We used the data of 169 hospitals (response rate 10.7%) in our analyses. Among them, 44 hospitals (26.0%) used acute-care pathways, and 107 (63.3%) used liaison pathways. There were forty acute-care pathways from 19 hospitals. The group using liaison and acute-care pathways had higher bed occupancy rates and shorter average length of hospital stays than those without pathways (p = 0.01). About 40% of the acute-care pathways consisted of checklist designs (scheduled days of care were not decided). Only three pathways (33.3%) were above bed rest level within 2 days from the onset.</p><p>Discussion: The results suggest that the introduction of acute-care pathways lags behind compared to liaison pathways. Hospitals using both liaison and acute-care pathways might address the increase in bed occupancy turnover rates and shorten hospital days through managing the pathways. In the future, we need to develop and diffuse pathways which clearly state concrete care items and their schedule in order to facilitate early rising.</p>

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