Continuous Quality Improvement of Nursing Care: Case Study of a Clinical Pathway Revision for Cardiac Catheterization

• Published in: The Journal of Nursing Research Vol. 19; no. 3; pp. 181 - 189
• Main Authors: 嚴玉華(Yu-Hua Yan), 陳怡(Yi Chen), 龔志銘(Chih-Ming Kung), 彭麗蓉(Li-Jung Peng)
• Format: Journal Article
• Language: English
• Published: 台灣 台灣護理學會 01.09.2011; 臺灣護理學會; Lippincott Williams & Wilkins, Inc
• Subjects: Cardiac Catheterization; clinical pathway revision; continuous quality improvement; Critical Pathways; Fees, Medical; Length of Stay; MEDLINE; Nursing; SCIE; Scopus; SSCI; Taiwan diagnosis related groups (Tw-DRGs); Total Quality Management; TSCI; TSSCI; 持續性醫療品質改善; 臨床路徑修正; 診斷關聯群; 診斷關聯群; clinical pathway revision; continuous quality improvement; Taiwan diagnosis related groups Tw-DRGs; 臨床路徑修正; 持續性醫療品質改善
• ISSN: 1682-3141; 1948-965X; 1948-965X
• DOI: 10.1097/JNR.0b013e318228cf46

Background: Taiwan's Bureau of National Health Insurance (BNHI) has been gradually introducing Taiwan diagnosis related groups (Tw-DRGs) for inpatient cases since 2010. Challenged to adapt to payment system changes, hospitals must implement necessary management control systems or measures to maintain both fiscal soundness and medical care quality.Purpose: This study investigated the outcome of management participation in work to revise cardiac catheterization clinical pathway operating procedures.Methods: BNHI-qualified cases for Tw-DRGs 125 payment principles were recruited as study subjects to revise the cardiac catheterization clinical pathway. Researchers compared pre-and postrevision values in terms of mean medical care fees, patient volumes, healthcare quality, and length of hospital stay, as well as financial risk.Results: Significant differences were observed in precardiac catheterization nursing care completion rates, mean lengths of hospital stay, diagnosis numbers, surgical treatment numbers, and numbers of complications or comorbidities. Medical utilization was also significantly lower (p＜.05) after revision implementation.Conclusions: Clinical pathway revision involves organization, procedural flows, and performance management. The revision successfully improved hospital finances and promoted medical care quality.