PubMed · 8850810
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D Locke. Filling the gap.. https://pubmed.ncbi.nlm.nih.gov/8850810/
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AIMS: To obtain an overall picture of the organisation of acute stroke management in hospitals throughout New Zealand. METHODS: A questionnaire was sent to all New Zealand hospitals. The survey included questions about access to organised stroke care, the presence of designated areas for stroke patient management, guidelines for stroke management and audit. RESULTS: Responses were received from all hospitals surveyed, with 41 admitting stroke patients acutely. Five hospitals (four regional and one large urban) had organised inpatient care. Five hospitals (three regional and two large urban) had stroke physicians. Only 40-60% of the New Zealand population had access to hospitals with guidelines for the management of complications following stroke or secondary prevention. Only fifteen of 41 hospitals had audited local stroke care. There were few differences in the management of stroke patients between urban and regional centres, but care in some regional hospitals was 'better' than that in most large urban hospitals. CONCLUSIONS: The development of an organised approach to inpatient stroke care in New Zealand and the training of general physcians, geriatricans and neurologists in stroke medicine must be seen as a priority.
Critical pathways are widely adopted by many large hospitals around the world in order to provide high-quality patient treatment. The development of critical pathways is a lengthy process, and may require the collaboration among physicians, nurses, and staffs in a hospital. The development and implementation of critical pathways at Kanto Medical Center and the transition to a computerized multidisciplinary documentation system took place between 2000 and 2001. The article describes the process of creating the automated documentation system to support the critical pathways. The advantages, pitfalls learned in this integration experience are described.
In Japan there is a possibility that diagnosis related group/prospective payment system (DRG/PPS) will be introduced as one means to decrease medical expenses in the future. Recently, measures to improve medical services, including approaches to improving medical care represented by evidence based medicine (EBM) and disclosure of medical information including clinical records, have been seen. The authors department is attempting to introduce clinical paths as one tool to cope with such changes in medical care circumstances. Using the tabulations of patients over the past year and major diagnostic classification (MDC) with the Japanese edition of DRG/PPS serving as a guide, we have prepared critical paths for ten diagnosis and treatment groups consisting of sudden deafness, tonsillectomy, laryngo-microsurgery, endoscopic sinus surgery, tympanoplasty, removal of parotid gland tumor, neck dissection, total laryngectomy, total pharyngo-laryngectomy and operation for tongue-oropharyngeal cancer. We report herein on the present status of the introduction of these critical paths at our department.