Introduction of Critical Path Guidlines into Cases Performed Distal Gastrectomy

Mutsumi Nozue, Tsunehiko Maruyama, Fumito Imamura, Masataka Fukue and Kouichi Kamiyama

Dept. of Surgery, Tsukuba Memorial Hospital

To prepare for the change in the health insurance system in Japan, critical path guidelines have been introduced to our hospital. In our surgical department, critical path for distal gastrectomy has also been inducted since autumn in 1998. To evaluate the effect of the induction, days in hospital and points for health insurance were compared between 10 cases treated using the critical path guidelines and 17 cases without critical path. The path prescribes the clinical course as follows: preoperative exam at outpatient clinic, 2 days stay befor operation, 16 days stay after operation. As a result, about 70% of patients followed this path. The average hospital stay has significantly decreased from 36 to 27.3 days after induction of the path. Average points for health insurance also significantly decreased from 165,800 to 133,900. Adjusting points by days in hospital to 19 days, showed that the medical care itself was also standardized under the critical path.

Key words
critical path, distal gastrectomy, health insurance

Reprint requests
Mutsumi Nozue Department of Surgery, Tsukuba Memorial Hospital, 1187-299 Kaname, Tsukuba, 300-2622 JAPAN

Accepted
December 22, 1999

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