Implementation of a Critical Pathway to the Dizzy Patients in the Emergency Center

ABSTRACT

BACKGROUND AND OBJECTIVES: Dizziness and vertigo are frequent causes of presentation in the emergency center. Nevertheless, the practice guideline for the primary care doctor in the emergency center has not been reported yet. Considering its complex approach for diagnosis, we developed critical pathway for dizzy patients who visited emergency center. We performed this study to show the process of development and the result of implementation of critical pathway. MATERIALS AND METHOD: A critical pathway was developed following the analysis of dizzy patients visiting emergency center by retrospective chart review and in the basis of questionnaire for knowing the needs for critical pathway to the primary care doctor in emergency center. Specialists for caring dizzy patients joined to make the flow sheet and practice guideline for dizzy patients and also made educational materials for doctors in emergency center. The critical pathway was then implemented and its results were analyzed by estimating the practice time and the degree of satisfaction of the patients and doctors. RESULTS: Most of the primary care doctors in emergency center reported the difficulty in diagnostic approach for dizzy patients and the need for critical pathway. More than half of the dizzy patients were diagnosed as peripheral vertigo and the commonest disease was benign paroxysmal positional vertigo. All of the patients with vertigo diagnosed as central origin showed the neurologic deficit. After the implementation of critical pathway, practice time was significantly decreased and many of the dizzy patients and doctors were satisfied. CONCLUSION: Development and implementation of a critical pathway for dizzy patient in emergency center was possible, valuable and effective for the patients and doctors, though the process was not easy and needed interdisciplinary cooperation of involving departments.