Application of different critical pathways for acute myocardial infarction patients depending on the patient condition after emergency percutaneous coronary intervention

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  • PCI 後の状態により選択し発行する急性心筋梗塞電子化クリティカルパスの試み
  • PCI ゴ ノ ジョウタイ ニ ヨリ センタク シ ハッコウ スル キュウセイ シンキン コウソク デンシカ クリティカルパス ノ ココロミ

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Abstract

<p>Critical pathways on paper-based medical charts for AMI patients were designed, and are presently in use in many hospitals. However, it is difficult to run under an electronic medical chart system because of its inflexibility. We recently designed 4 different critical pathways and applied them to AMI patients on an electronic medical chart system. The patients' conditions after emergency percutaneous coronary intervention (PCI) were classified into 2 groups：severe case and mild case. Moreover, progression of bed rest level, periodical blood sampling time and other post-PCI treatments, depend on the termination time of PCI. Therefore, we added a separate category according to termination time of PCI；one as the morning group (PCI ending from 0:00am to 12:00am） and the other as evening group (PCI ending from 0:00pm to 12:00pm). Under this definition, four different critical pathways：1) mild case morning group, 2) mild case evening group, 3)severe case morning group, and 4)severe case evening group, were defined. The appropriate critical pathway is selected from 4 critical pathways followed by the post-PCI patient condition and the termination time of PCI. A critical pathway in the mild case group consists of 4 different periods：the acute period, the recovery period, the rehabilitation period, and the discharge period. In the severe case group, 7 different periods are set. Physician starting the critical pathway after the end of PCI and has to choose additional treatment such as：periodical blood sampling, IABP use, oxygen use and others during the initiation of the acute period.</p><p> These critical pathways have already been applied to 29 patients, and reflect the actual clinical course of most of those cases.</p>

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