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Providing effective inpatient care for cirrhosis by improving utilization of national guidelines
Tracy Ellen Smith1,2,3, Khara' Jefferson1
1Frontier Nursing University, Hyden, Kentucky.
Insights
Cirrhosis care improved by 22% using a guideline checklist and patient engagement. This quality improvement initiative enhanced inpatient treatment for cirrhosis, increasing guideline adherence and patient participation.
Area of Science:
- Hepatology
- Quality Improvement Science
- Patient Care Management
Background:
- Cirrhosis incidence and mortality have significantly increased.
- Treatment complexity and costs for cirrhosis complications are rising.
- Existing care guidelines for cirrhosis are not consistently followed.
Purpose of the Study:
- To improve the adherence to cirrhosis care guidelines by 20% within 90 days.
- To implement a guideline-based checklist and chart audit process.
- To enhance the quality of inpatient care for cirrhosis patients.
Main Methods:
- A quality improvement initiative utilizing four Plan-Do-Study-Act cycles.
- Development and implementation of a guideline-based cirrhosis checklist.
- Incorporation of a shared decision-making tool for patient engagement.
- Regular chart audits and team meetings to monitor progress.
Main Results:
- Achieved a 22% improvement in guideline-based cirrhosis care.
- Reached 100% utilization of the guideline-based checklist.
- Secured 96% patient participation in shared decision-making.
- High team engagement and satisfaction throughout the project.
Conclusions:
- An evidence-based approach effectively improved inpatient cirrhosis care.
- Provider and patient engagement are crucial for successful quality improvement.
- The implemented strategies led to high participation and positive outcomes.
Background:
Over the past 10 years, cirrhosis incidence has increased dramatically, with a 59% increase in the need for treatment of disease complications. Cirrhosis treatment complexity and cost have increased substantially, and cirrhosis deaths are increasing by 10.5% yearly.
Local Problem:
A review of 29 cirrhosis admissions revealed that guideline criteria were only addressed 66% of the time on 10 key cirrhosis issues. After identifying gaps in care, the project aimed to improve right care for cirrhosis by 20% within 90 days by using a guideline-based checklist and chart audit process.
Methods:
The quality improvement (QI) initiative used four Plan-Do-Study-Act cycles. Cycles included tests of change for the checklist, patient engagement, chart audit, and team participation.
Interventions:
A guideline-based cirrhosis checklist focused on providing right care for cirrhosis patient admissions. Patient engagement was addressed with a shared decision-making tool. To monitor data, a chart audit was created. Team engagement included biweekly QI meetings with an agenda and a postmeeting survey.
Results:
The project aim was achieved, improving cirrhosis guideline-based care by 22%, while utilization of the guideline-based checklist rose to 100%. Moreover, 96% of patients approached for shared decision making agreed to participate, and the chart audit was completed on all patients. Team engagement and satisfaction remained high throughout the cycles.
Conclusions:
The project team used an evidence-based approach to effectively improve inpatient care for cirrhosis. Engaging providers and patients with this approach led to high patient and team participation and improved project outcomes.
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