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J Korean Soc Emerg Med > Volume 26(6); 2015 > Article
Journal of The Korean Society of Emergency Medicine 2015;26(6): 585-590.
응급진료센터에 내원한 분만후출혈 환자를 대상으로 개발된 표준진료지침 적용의 효과
왕진원, 이지환, 김민정, 박유석, 박인철
연세대학교 의과대학 응급의학교실
The Effect of Clinical Pathway for Patient with Postpartum Hemorrhage in the Emergency Department
Jinwon Wang, Ji Hwan Lee, Min Joung Kim, Yoo Seok Park, In Cheol Park
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
Correspondence  Ji Hwan Lee ,Tel: 02) 2228-2460, Fax: 02) 2227-7908, Email: kerokeropi@yuhs.ac,
Received: July 16, 2015; Revised: July 16, 2015   Accepted: September 15, 2015.  Published online: December 30, 2015.
ABSTRACT
Purpose:
Postpartum hemorrhage (PPH) is a major cause of maternal death. The aim of this study is to analyze the effect of clinical pathway (CP) and off-hours effects in PPH patients who visit the emergency department.
Method:
A retrospective study of PPH patients who visited the emergency department between December 1, 2005 and February 28, 2014 was conducted. A multidisciplinary team was designed for PPH in August 1, 2009. We compared time to intervention, volume of transfusion, length of stay (LOS), and uterus preservation rate between the before CP group and after CP group.
Results:
A total of 143 post CP groups were compared with 101 before CP visits. Time to operation was less compared with the pre CP group (77 min (22-140) vs 47.5 min (13-114) p=0.011). Volume of transfusion and admission to intensive care units (ICU) were increased in the post CP group. (2 (0-16) vs 2 (0-25) p=0.045, 20 (19.8%) vs 54 (37.8%) p=0.003) LOS of ICU was lower than in the pre CP group and uterus preservation was higher than in the pre CP group. (0 day (0-43) vs 0 day (0-6) p=0.015, 82 (81.2%) vs 129 (90.2%) p=0.042) Time to angiographic embolization was less in the post-CP group with on-duty visits than in post-CP with off hours visits. (38.50 min (16-112) vs 71.0 min (28-633), p=0.025).
Conclusion:
A clinical pathway for PPH is associated with improvement of uterine preservation rate and reduced LOS of ICU. However this CP could not eliminate off-hour effects from time to intervention.
Key words: Postpartum hemorrhage, Clinical pathways, Emergency medicine
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