Activity level is not always equal among the patients who have had orthopedic surgery and rehabilitation therapy when they leave the hospital, because pre-operative activities, personal conditions and their circumstances vary. Activity levels of patients might be different at discharge from hospital, because the timing of discharge was dependent on the social problems or activity levels before admission to hospital were variable among patients. So the sentence that means activity levels, such as “one crutch gait”, should be improper in describing discharge outcomes in clinical pathways. We developed a “rehabilitation chart” that can be used in all cases, with variable conditions, as a secondary clinical pathway in addition to the basic clinical pathways which are used mainly by nursing staff in pre-and post-operation status.

　On this chart, the rehabilitation plan is divided into levels, for example, for “safely transferring to wheel chair", “two crutch gait”, or ‘‘free gait”. Before starting rehabilitation training, medical staff, patients and family decide on which step in the rehabilitation process should be reached before discharge (or whether to continue through to final rehabilitation) based on the patient's pre-operative activity, personal conditions and the circumstances, and rehabilitation training and self-training are to be continued even after a discharge or a second admission to another hospital according to this chart.

　This chart is useful as a check sheet for a standard training program with which all medical staffs bind the patients until they reach the rehabilitation goal.

　This rehabilitation chart was useful to make the better understanding between medical stuff and patient, to communicate smoothly among medical stuff and to discuss quality of the standardized plan.

　Many experience of usage this chart would improve this rehabilitation chart to establish the more understanding all around, we hope.

　The clinical pathways of our clinic use the all-in-one path format, and are prepared by standardizing past data. We have developed an outcome setting sheet to decide what kind of items are specified as the daily attainment target (outcome) and included in the daily activities. The outcome setting sheet consists of six types of formats. First of all, problems that are appraised from the clinical condition at the time of admission are considered, and they are categorized within the expressions of the attainment targets. Then, the standard for each attainment target, what should be done to judge the standard, what should have been attained before attaining the target, what should be done to attain the target, and problems that occur attaining this target are reviewed. The next attainment target is derived, and the same review is repeated to the attainment target. ln this way, in order to judge the attainment target and standard which were acquired, data is collected from the past chart and is standardized. The results are arranged in chronological order, and an overview sheet is prepared. This concept is called the "Patient problem solving outcome thinking on admission type”. The clinical pathways of a total knee arthroplasty on one side were prepared. In total, 231 items were selected as the attainment targets. 172 items should be executed for judgment, and 72 items are regarded as necessary for preparation of the clinical pathways in addition to the above. The data of 475 items in total were collected and standardized.

【Purpose】Prostate cancer is a commonly diagnosed malignancy in men. Radical prostatectomy is an effective treatment for clinically localized carcinoma of the prostate. Clinical pathways were implemented to standardize the therapy (prostatectomy) of prostate cancer. We evaluated the usefulness of the clinical pathway for portless endoscopic urological surgery in prostate cancer.

【Method】The subjects were 20 patients undergoing radical prostatectomy. The time periods of medical treatment such as the first meals after surgery, removal of the urethral catheter and postoperative admission days were standardized. The patients answered a questionnaire that stated their degree of satisfaction.

【Results】Using this clinical pathway, 90% of the patients could begin eating and walking 2 days after surgery. 85% of the patients had their urethral catheters removed within 7 days after the operation. 85% of the patients were discharged ten days after the operation. 3 patients needed to stay in the hospital longer because of urinary retention, surgical site infection, or insufficient anastomosis of the bladder neck. Surgical site infection occurred in 1 prostatectomy case (5%). Urinary continence, which was defined as wearing no pads, gradually improved during the first month after surgery, and at 3 months, 88.9% of the patients were dry. ln this study, more than 90% of the patients were satisfied with the operation and hospital stay.

【Conclusion】The clinical pathway is considered to be a good tool for giving higher quality and better service to patients. We recognized the importance of deciding the outcome such as the first meal after surgery, postoperative admission days and the removal of the urethral catheter when developing the clinical pathway.