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要約 当院眼科に医療チーム用のクリニカルパス(CP)を導入した。CPの対象は,白内障,斜視,緑内障,白内障・緑内障同時手術,黄斑円孔硝子体手術,増殖糖尿病網膜症硝子体手術,網膜剝離バックル手術,網膜剝離硝子体手術,その他の硝子体手術の9種類とした。その使用状況とバリアンス(逸脱症例)を10か月間検討した。眼科病棟の入院患者は214名で,うち134名158眼に手術を行った。CP使用例は125眼,不使用例は23眼で,その他に角膜移植や涙囊鼻腔吻合術などCPの非適応症例10眼があった。バリアンスは全体で51.2%に発生した。白内障手術でのバリアンス発生は38%で,他の手術ではバリアンス発生が高かった。バリアンス発生の最も多い理由は患者合併症であった。
Abstract. We introduced clinical pathways for the medical team in the ophthalmology ward. We designed nine types of clinical pathway for cataract,strabismus,glaucoma,combined cataract and glaucoma surgery,vitreous surgery for macular hole,proliferative diabetic retinopathy,retinal detachment and other vitreous diseases,and scleral buckling for retinal detachment. We reviewed the actual use of clinical pathway and variances during a 10-month period. Out of 214 hospitalized patients,surgery was performed on 158 eyes of 134 patients. Clnical pathway was used in 125 eyes and was not used in 23 eyes. Additionally,there were 10 eyes of keratoplasty or dacryorhinostomy for which clinical pathway was not applicable. The overall incidence of variance was 51.2%. It was 38%in cataract surgery and was higher in other surgeries. Complication in the patient was the major cause of variances.
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