Continuous Quality Improvement of Nursing Care: Case Study of a Clinical Pathway Revision for Cardiac Catheterization

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Taiwan's Bureau of National Health Insurance (BNHI) has been gradually introducing Taiwan diagnosis related groups (Tw-DRGs) for inpatient cases since 2010. Challenged to adapt to payment system changes, hospitals must implement necessary management control systems or measures to maintain both fiscal soundness and medical care quality.


This study investigated the outcome of management participation in work to revise cardiac catheterization clinical pathway operating procedures.


BNHI-qualified cases for Tw-DRGs 125 payment principles were recruited as study subjects to revise the cardiac catheterization clinical pathway. Researchers compared pre- and postrevision values in terms of mean medical care fees, patient volumes, healthcare quality, and length of hospital stay, as well as financial risk.


Significant differences were observed in precardiac catheterization nursing care completion rates, mean lengths of hospital stay, diagnosis numbers, surgical treatment numbers, and numbers of complications or comorbidities. Medical utilization was also significantly lower (p < .05) after revision implementation.


Clinical pathway revision involves organization, procedural flows, and performance management. The revision successfully improved hospital finances and promoted medical care quality.

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