Retrospective assessment of the implementation of critical pathway in stroke patients in a single university hospital.
OBJECTIVE
To evaluate the effects of the implementation of critical pathway (CP) in stroke patients treated at a single university hospital.


METHODS
A retrospective medical review collected data from 497 patients who had suffered acute stroke in the rehabilitation center. Stroke outcomes were compared between before and after the implementation of CP based on factors including demographic factors, stroke characteristics, pre-existing medical conditions, medical complications, functional states, and length of stay (LOS).


RESULTS
After the implementation of CP, the patients showed significantly higher stage for upper proximal (p=0.008) and lower extremity (p=0.001) on Brunnstrom stage and significantly lower scores for modified Rankin Scale (p=0.003) at transfer. For those with pre-existing medical conditions, there were significantly increased osteoarthritis (p=0.002) and valvular heart disease (p=0.011). Regarding medical complications during acute inpatient rehabilitation, there were significantly decreased shoulder pain (p=0.001) and dysphagia (p=0.017), and significantly increased gastrointestinal symptoms (p=0.001). Functional gain and efficiency of stroke patients during rehabilitation center hospitalization did not significantly change after implementation of CP. But, shorter LOS of total hospitalization, pre-rehabilitation center hospitalization, and rehabilitation center hospitalization were evident.


CONCLUSIONS
After the implementation of CP, patients less often developed complications and displayed no changes in functional gain and efficiency. They had shorter LOS of total hospitalization, pre-rehabilitation center hospitalization and rehabilitation center hospitalization.
Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea. ; Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea.
Jin Hoan
JH
Kim
Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea. ; Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea.
Ha Young
HY
Byun
Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea. ; Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea.
Seungnam
S
Son
Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea. ; Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea.
Joong Hoon
JH
Lee
Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea. ; Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea.
Chul Ho
CH
Yoon
Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea. ; Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea.
Eun Shin
ES
Lee
Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea. ; Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea.
Heesuk
H
Shin
Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea. ; Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea.
Min-Kyun
MK
Oh
Complications; Critical pathways; Rehabilitation; Stroke