Development and Application of the Critical Pathway in Perioperative Patients with Ventricular Septal Defect

ABSTRACT

BACKGROUND AND OBJECTIVES: Ventricular septal defect (VSD) is the most common congenital heart disease, and an effective cooperative practice system can change its therapeutic outcome. We tried to develop and find the effects of the application of the critical pathway (CP) in patients with VSD. MATERIALS AND METHODS: First, we reviewed the charts of patients diagnosed with VSD who had been operated on between January and December 1999, and the preliminary CP for the VSD completed. Second, the Delphi process was achieved by exchanging mail between two professional groups to establish the final CP for the VSD. This process was applied to thirteen patients having had operations at the Gil Heart Center between June and November 2000. On admission, the patients were informed of the practice, and their degree of satisfaction was anonymously surveyed prior to discharge. RESULTS: The CP for patients with VSD is composed of eight categories - monitoring, vital signs, laboratory tests, ventilator, diet (fluid-electrolyte balance), drugs, treatment, consultation and education. These were applied and evaluated daily from two days preoperatively, until the day of discharge (seven days postoperatively), to 13 of the 15 (86.7%) patients, as approved in the instruction manual. The duration of antibiotic injections significantly decreased from 5.3+/-1.3 days to 3.1+/-0.5 days (p=0.00002), as did that of thoracic tube insertion from 84+/-21 hours to 48+/-16 hours (p=0.0001). The degree of satisfaction of the parents was 4.2, the highest score possible being 5. CONCLUSION: Improvement in the quality of medicine can be achieved by developing and applying the CP to perioperative patients with VSD. Our conclusions from this study are only tentative as it was only applied to limited small number of cases.