Sastrawan, I Gede
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Development of Caesarean Section Clinical Pathway : a lesson learnt Sastrawan, I Gede
Jurnal Kedokteran Brawijaya Article in Press 2
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

Clinical pathway is a crucial clinical management strategy aimed to ensure quality and cost. However, the development of clinical pathway at the hospital was mainly for administrative purpose as it is required by accreditation standards leading to high variation. Study aims to develop clinical pathway for caesarean section and explore the problem during development and initial implementation (simulation). The selection of caesarean section is based on its high volume, risk, and cost. Using participatory action research, the researcher started the program by performing literature review and regulation to proposed the first revised version draft. A group of relevant expert in the hospitals than discuss and proposed review, considering the available resources, current practice and behavior. The main differences of the new clinical pathway are: 1) it was developed based on literature and current practice, 2) adding notification, explanation, inclusion and exclusion criteria, and references.  Before initial implementation (simulation), the hospital also develop a procedure operational standards for the implementation, resources, and monitoring.  The first simulation on two cases found differences in type of medication and documentation method, which than further discussed with all care providers involved to define the agreed solution. Professional engagement and openness culture that embrace along the process are the main important key lesson learnt in addition to the understanding that clinical pathway development and implementation is a continuous learning process. Therefore continuous monitoring and evaluation is of paramount important to reach quality and efficiency, the ultimate goals of clinical pathway.
Development of Caesarean Section Clinical Pathway: A Lesson Learned Sastrawan, I Gede; Wardhani, Viera
Jurnal Kedokteran Brawijaya Vol. 31 Supplement 2 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.02.7s

Abstract

Although clinical pathway (CP) is aimed to ensure quality and cost, the development of CP at hospitals is primarily for administrative purposes as it is required by accreditation standards, thus causing high variations in its implementation. This study aimed to develop a clinical pathway for caesarean section and explore the problem during development and implementation test. The selection of caesarean section was based on high volume, risk, and cost. Using participatory action research, the researcher started the program by performing an implementation evaluation, literature review, and regulatory development. The evaluation identified implementation discrepancies and prolonged length of stay. Based on the evaluation and literature review results, the Professional Care Provider (PCP) in the hospital conducted discussions and made suggestions by considering available resources, current practices, and behavior. The main differences of the new clinical pathway are: 1) it is developed based on literature and current practice, and 2) it should be added with notification, explanation, inclusion and exclusion criteria, and references. Before the implementation test, the hospital provide resources, develops a standard operational procedure followed by monitoring and evaluation. Differences in the type of medication and documentation method were found, which then further discussed with all involved PCP to define the agreed solutions. Professional engagement and openness culture that embraces along the process are the main key lesson learned in addition to the understanding that CP development and implementation is a continuous learning process.