The purpose of this study was to develop a critical pathway for case management of patients who have received Lumbar Laminectomy because of low back pain, arm and leg numbness, and radiating pain in the leg. For this study, a preliminary critical pathway was developed through a review of the literature including five critical pathways which are currently being used in the USA. In order to identify the overall service contents required by these patients, 30 cases were analyzed. These cases were taken from medical records of those with Lumbar Laminectomy between January, 1998 and December, 1998 in the department of neurosurgery at the Pusan National University Hospital in Pusan. An expert validity test was done for the preliminary critical pathway, a clinical validity test was also done using 12 patients with Lumbar Laminectomy between October 1, 1999 and January 31, 2000. After these processes, the final critical pathway was developed. The results are summarized as follows. 1. The vertical axis of the critical pathway includes the following eight items: assessment, consultation, diet, test, medication, treatment, activity, education/ discharge planning. The horizontal axis includes the time from the start of hospitalization to discharge. Analysis of the 30 medical records was done. analysis of the service contents showed the horizontal axis of the preliminary critical pathway was set from hospitalization to the 12th post operation day and the vertical axis was set to include eight items, the contents which should have occurred, according to the time frames of the horizontal axis. 2. As a result of the expert validity test, it was found that among the 233 items, 203 showed over 88% agreement and 30 of them showed less than 88% agreement, which were then revised or deleted from the critical pathway. At the preliminary meeting for the clinical validity test, the time of hospitalization on the horizontal axis was shortened to the 10th post operation day. A clinical validity test was done with 12 patients with Lumbar Laminectomy. All the cases progressed according to the critical pathway although some variances were noted in assessment, consultation, test, medication, and treatment. 3. Based on these results, a final critical pathway was determined. In conclusion, this critical pathway is partially applicable to the care of patients with Lumbar Laminectomy and needs further investigation.

The purpose of this study was to develop a critical pathway for the patients following lumbar laminectomy. Development of this critical pathway was the fundamental phase to implement case management, which is a new health care delivery system. For this study, a preliminary critical pathway was developed first through a literature review and analysis of the medical records and seven critical pathways being used currently in Korea and the USA. In order to identify the health care services provided for the patients, who had lumbar laminectomiess and to draw up the conceptual framework, 30 medical records were analyzed from January, 1997 to December, 1997 at the Spinal Center in the Yonsei University Medical Center. The results of this study are as follows: 1. The vertical axis of the critical pathway included the following 7 items: test, assessment, treatment, activity, medication, diet, teaching and discharge planning; and the horizontal axis included the time frame from the pre-operative day to the third post-operative day. 2. Analysis of the 30 medical records indicated that the average length of stay was 13.7 days, including 4.8 days from admission to operation, and 8.9 days from operation to discharge. 3. According to the validity study using seven experts, 54 items, among the total of 86 items, reached over 86% agreement, while 32 items showed less than 86%. These 32 items were reviewed for deletion or modification before inclusion. A final critical pathway then was developed. On the basis of this research, it is anticipated that this critical pathway can be uesd in clinical situations to provide care for the patients following lumbar laminectomy in the most effective and efficient manner.