ผลการใช้ Care Map ในการดูแลผู้ป่วยบาดเจ็บที่ศีรษะรุนแรง

Abstract

Background: Severe head injury is the frequent medical problem (about 2% of population) and tends to be more severe. Patient may died without prompt medical intervention or resulted in complications and disability which is troublesome to the family. Development of severe head injury patient care by care map will improve the effectiveness of care.
Objective: To study and compare outcome of severe head injury care map before and after implementation.
Setting: Surgery department, Surin hospital
Study design: Action research
Sample: Sample of 30 cases from each before and after care map implementation was specifically random.
Method: Data was collected from 1^st January 2007 to 31^st December 2008. Research tools were three assessment forms and descriptive statistic presented by number, mean, percentile and standard deviation.
Result: The study found that before care map implementation; there was only 76.2% to adhere the patient care guideline. Rate of respiratory tract infection was 15.6:1000 intubation days and urinary tract infection rate was 0.9:1000 cateterize days. Bed sore was found 1.3:1000 patient days and average length of stay was 13.9 + 7.6 days with average total hospitalization cost of 55,658.3 + 36,673.1 Baht. After care map implementation; adherence to patient care guideline was 86.2%. Respiratory tract infection rate was 10.9:1,000 intubation days and bed sore rate was 1.1:1000 patient days while urinary tract infection was not found from this group. Average length of stay was decrease to 11.7 + 4.9 days and average total hospitalization cost was 40,170.8 + 24,620.4 Baht.
Conclusion: Adherence to the severe head injury care map improved the quality of care to these patients, decreased complications, length of stay and total hospitalization cost.
Key words: Care map, Severe head injury