Optimizing Urgent Care Processes Improves Outcomes for Hospitalized HE Patients

Patients with hepatic encephalopathy (HE) often do not seek care until they are in critical condition, making an optimized urgent care process essential to reduce adverse prognoses and improve clinical symptoms .

According to a study published in International emergency medicine.

HE is the loss of brain function due to chronic, severe liver disease, which occurs when a damaged liver cannot remove toxins from the blood. Appropriate emergency care for patients with HE can improve their prognosis and quality of life, the authors wrote.

“Because [HE] often begins insidiously, most patients do not seek treatment until the advanced stage of the disease, when they are mostly in critical condition with complex changes, and if emergency care is not timely or inappropriate, they can affect the quality of life of patients in the later stages, and in severe cases, it can be life-threatening,” they explained.

Although standardized emergency procedures are crucial when treating HE, the lack of a unified process led to delays in resuscitation time, the authors added. In their study, they compared the outcomes of HE patients receiving conventional nursing emergency procedures with those receiving optimized nursing emergency procedures.

A total of 66 patients admitted to Xiangya Second Hospital in China between May 2020 and February 2022 were included in the study. Half (33 cases) were in the control group given the convention process and the remaining 34 cases were the observation group given the optimized process.

The control group process included:

  • General emergency measures
  • When the condition stabilized, the patient’s vital signs, major symptoms and physical signs were closely monitored
  • Nursing staff reassessed patient and applied medication for hepatic encephalopathy, treated primary disease

The observation group process included:

  1. The consultation process has been optimized with the direct sending of the patient to the resuscitation room
  2. The ambulance process has been optimized with an integrated pre-hospital ambulance
  3. The patient’s physical condition and vital signs were reassessed every 10 to 15 minutes
  4. The emergency department held monthly meetings to summarize problems nurses witnessed and to improve the level of emergency nursing staff.

Compared to patients in the control group, patients who received the optimized process spent less time on diagnosis, resuscitation, and referral to appropriate care teams. In the control group, there was a success rate of 93.7%: 26 patients were discharged with a cure, 4 patients were discharged with an improvement and 2 died due to ineffective first aid. In the observation group, the success rate was 100%, with no patient dying; 29 patients were discharged with healing and 5 patients were discharged with improvement.

The researchers also found that scores related to quality of ambulance technique, humanistic care, resuscitation efficiency and resuscitation effect were significantly higher for the group receiving care optimized by compared to the control group (P

Satisfaction of the families of treated patients was also higher in the observation group. In the control group, less than half (46.88%) said they were very satisfied with clinical care, compared to more than three quarters (76.47%) in the observation group. Only 5.88% of families in the observation group said they were dissatisfied with nursing care compared to 28.13% in the control group. The overall satisfaction rate of the control group was 71.88% against 94.12% in the observation group.

“After optimizing the emergency care process, a standard emergency care process can reduce unnecessary ties, and the patient’s condition can be systematically, comprehensively and timely assessed to avoid delaying the time emergency because of the multidisciplinary consultation, which can not only improve the resuscitation success rate but also improve the resuscitation effect,” the authors wrote.

Reference

Wei F, Tan H, He Y, Xin S. Impact of emergency care process optimization on urgency effect and prognosis of patients with hepatic encephalopathy. Emergency Med Int. 2022;2022:4446215. doi:10.1155/2022/4446215

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