Risk Management and Healthcare Policy (Nov 2023)
Clinical Pathway for Enhanced Recovery in the Management of Non-Variceal Upper Gastrointestinal Bleeding: A Randomized Controlled Trial
Abstract
Yan-Yan Zhang,1,2,* Qiao-Xian Zhang,3,* Jun-Ting Li,1 Yan Wang,1 Ze-Hao Zhuang,4,5 Jia-Yuan Zhuang1 1School of Nursing, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China; 2School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People’s Republic of China; 3Department of Nursing, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People’s Republic of China; 4Endoscopy Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People’s Republic of China; 5Department of Gastroenterology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ze-Hao Zhuang, Endoscopy Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China, Tel +8613178032412, Email [email protected] Jia-Yuan Zhuang, School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Fuzhou, Fujian, People’s Republic of China, Tel +8613860669060, Email [email protected]: To explore the effects of the clinical pathway on the outcomes of patients with non-variceal upper gastrointestinal bleeding.Materials and Methods: Randomized controlled trial. The study was conducted in two medical centers in China from 1 June 2022 to 31 December 2022. Patients with a diagnosis of non-variceal upper gastrointestinal bleeding who provided written informed consent were consecutively assigned to the intervention group. The patients in the intervention group were treated using the clinical pathway, while the control group received routine care and follow-up. Time, cost, complications, and prognostic indicators were analyzed. Intentional-to-treat analysis and per-protocol analysis were used for data analysis.Results: A total of 114 eligible patients with non-variceal upper gastrointestinal bleeding were randomly divided into two groups and included in the intention-to-treat analysis. In addition, 106 patients were included in the per-protocol analysis. The median age of the 106 patients was 57 years (range, 18– 92 years) and 83.0% were male. There were no significant differences between groups regarding the baseline characteristics. The intervention group demonstrated a statistically significantly shorter length of stay, lower hospital cost (ie, cost during hospitalization, cost in the emergency room, and cost in the ward), significantly fewer cases of complications, and a higher level of patient satisfaction when compared with the control group. There was no significant difference between the two groups in the rates of transfusion, repeat endoscopy, rebleeding readmission, and mortality.Conclusion: The implementation of the clinical pathway for patients with non-variceal upper gastrointestinal bleeding may help improve patient outcomes and satisfaction.Trial Registration Number: ChiCTR2200060316.Registration Link: https://www.chictr.org.cn/.Keywords: clinical pathway, medical-nursing integration model, non-variceal upper gastrointestinal bleeding, patient, outcomes
