脳卒中とクリティカルパス・ガイドライン 脳卒中クリティカルパスの現状

Abstract

The use of critical pathway is becoming increasingly important in acute stroke therapy. Rehabilitation in the recovery stage could be done in the specialized rehabilitation hospitals within Kumamoto according to inter-hospital cooperation. Our acute stroke team can concentrate on the treatment of stroke in the acute stage (within 2-3 week from the onset). We have been developing this stroke management system based on an acute stroke unit with referral to a rehabilitation unit in other hospital (inter-hospital referral model) in con-trast to the conventional system with a combined acute and rehabilitation stroke unit in a single hospital (intra-hospital referral model). Our outcome of critical pathway for stroke is not only discharge to home but also transfer to a rehabilitation hospital.After the introduction of 3 types of critical pathway dedicated for various severity of acute ischemic stroke in 1995, the average length of hospital stay of both stroke and non-stroke patients declined from 30.0 days (1993) to 23.3 days (1995), and 13.9 days (2000) in our department. Now we have 5 types of stroke criti-cal pathway.Critical pathway increased quality of care, and contributed to integrated multidisciplinary collaborations among various specialist, nursing and other paramedical personnel. Critical pathways should be viewed as components of total quality management. They should not be allowed to restrict the patient's or physician's choice of interventions, they should not inhibit in any way innovation or the introduction of novel methodologies. Yet, critical pathways generate a pressure on every member of the acute stroke tam, a sense of negative entropy constantly urging a move toward a higher level of excellence and quality.The reduction of length of hospital stay was achieved by the use of critical pathway and the inter-hospital cooperation.