Purpose: The purpose of this study was to build the outline of a clinical pathway for appendicitis adjusted for DPC (Diagnosis-Procedure combination).

　Patients and method: In this study, 285 patients who underwent an appendectomy during the period from April 2002 to March 2005 were evaluated. The age of the patients, WBC (white blood cell counts), CRP (C-reactive protein), severity of the appendicitis (catarrahlis, phlegmonous, gangrenous), severity of the peritonitis (no-peritonitis, pyoascites, localized intra-abdominal abscess, diffuse peritonitis) and whether intra-abdominal drainage was performed or not, were statistically analyzed by ANACOVA in order to establish the correlation with the duration of hospital stay.

　Results: The age of the patients, CRP and whether intra-abdominal drainage was performed or not, were found to be statistically correlated with the duration of hospital stay. The patients could be classified into three groups using the following three items: Group I (CRP <10mg/dl; drainage not performed), Group II (CRP >＝10; drainage not performed), and Group III (drainage perforrned). The duration of hospital stay for the clinical pathway of each group was determined referring to DPC as follows: Group I four days, Group II nine days, Group III nineteen days. 75.9% of patients in Group I, 92.3% of patients in Group ll and 82.0% of patients in Group III corresponded to this duration of hospital stay.

　Conclusion: Clinical pathways for appendicitis based on its severity may be drawn up referring to the age of the patients, CRP and whether drainage was performed or not. This study may therefore show a viable model to establish clinical pathways based on the relevant data at each institution.

　In daily practice for clinical pathways, cooperation between medical team members is important. In particular, the contribution of the nurse who plays a role of coordinator in the team is essential. Therefore, it is inferred that nurses' knowledge and awareness of the need for team participation in relation to clinical pathways will influence related practices and variance judgments.

　From this viewpoint, in order to grasp the present state of nurses' knowledge and awareness in connection with the breast cancer surgery clinical pathway, a questionaire survey with unsigned forms was carried out on the nurses in a certain hospital. Findings revealed that the clinical pathway has been operated rather vaguely and with inadequate knowledge, making variance judgments difficult in daily nursing services. Moreover, potential conditions were grasped in which the over-expectation for work reduction may damage the foundation for operation processes geared toward the achievement of clinical pathways.

　These results suggest noteworthy points to be considered in order to realize sound practice for clinical pathways in daily nursing services and planning improvements.