รูปแบบการจัดการรายกรณีผู้ป่วยโรคหลอดเลือดสมองตีบอุดตันเฉียบพลัน ห้องฉุกเฉิน โรงพยาบาลสกลนคร A Case Management Model for Acute Ischemic Stroke Patients at Emergency Department, Sakon Nakhon Hospital

Abstract

The objectives of the participatory action research were to develop a case management model for acute ischemic stroke patients and to evaluate the effectiveness of the case management model for acute ischemic stroke patients at Emergency Department, Sakon Nakhon Hospital . The Researcher collected data by in-depth interview, focus group, observe and questionnaire.  The key informants comprised of two groups. The first  group were to  develop the case management model and the second group were to  evaluate the effectiveness of the  case management model. Data were analyzed by quantitative data analysis, frequency percentage and Chi square test. The qualitative data using content analysis.

The results found that; 1) Situation analysis were an issue that indicate an opportunity to develop  a model for acute ischemic stroke patients, as follows : the stroke fast track included pre-hospital phase and first 24 hours of admission in intensive care unit, clinical nurses practice guideline for  acute ischemic stroke patients, clinical specialist nurse case manager assigned in the emergency room and training   specific competency for emergency nurses, the emergency nurses in community hospital network, screening emergency severity index, the model encourages citizens to be alarm signs of stroke, and call for emergency medical services 2) The case management model for acute ischemic stroke patients composed of 5 components including ; 2.1) The stoke service delivery policy and strategic plans  2.2) The ER stroke nurse case manager function base on the clinical nurse case manager and extended role to pre-hospital phase ,emergency room and first 24 hours of admission in intensive care unit. Collaborate with multidisciplinary teams and competent emergency nurses. 2.3) The “8 D of stroke and first 24 hours of admission in intensive care unit”  clinical nurse practice guideline of acute ischemic stroke patients  included  pre-hospital and in-hospital phase 2.4) The stoke multidisciplinary teams and the emergency nurses in community hospital network at Sakon Nakhon province. and 2.5) The outcomes management  composed of  quality of nursing and health service outcomes, and 3) The effectiveness of  the case management model found that the quality of nursing were the multidisciplinary  teams’ s satisfaction was the highest level (X̅ = 4.90), patients and families ’s satisfaction was  the highest level (X̅ = 4.93) and 97.16 % of specific competency. The health service outcomes were prepared                   pre-intervention and post-intervention found that both the emergency medical services system called , the acute ischemic stroke patients access to stroke fast track , access to fibrinolysis  ,shorten time to fibrinolysis and  24 hrs. in hospital mortality rate were  different  at level of statistical significance(P <0.05).