Article Text

other Versions

PDF
Improving management of oesophageal varices in patients with cirrhosis
  1. Rachel Wundke,
  2. Rosalie Altus,
  3. Jayne Sandford,
  4. Alan Wigg
  1. Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Adelaide, Australia
  1. Correspondence to Dr Alan Wigg, Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Bedford Park SA 5042, Australia; alan.wigg{at}health.sa.gov.au

Abstract

Problem A retrospective audit of management of oesophageal varices in patients with cirrhosis identified the need to improve adherence to guidelines.

Design Prospective audit of the effect of disseminating guidelines in 2004; prospective audit of the effect of a nurse coordinator for oesophageal variceal screening and surveillance from 2005 to 2008.

Setting A major public hospital in Australia 2001–2008. Patients with cirrhosis of the liver and those who had experienced a variceal bleed were studied.

Key measures for improvement (1) Adherence with primary prevention protocols for prevention of primary variceal bleeding in patients with cirrhosis of the liver. (2) Adherence with protocols for acute management of variceal bleeding and secondary prevention of bleeding.

Strategies for change Local protocols were developed and disseminated. A nurse coordinator was introduced to manage the primary prevention process according to a clinical protocol.

Effects of change The introduction of a nurse coordinator to manage the primary prevention process resulted in dramatic and rapid improvements in primary prevention. This has been maintained with our target of 90% adherence being achieved for the last 3 years.

Lessons learnt Disseminating guidelines had little effect on primary prevention practice. Less than 1 year after a nurse coordinator was introduced to manage primary prevention, adherence to primary prevention guidelines increased from 13% to 79%. However, significant improvements in the management of acute variceal bleeding where medical staff have a clear responsibility for patient care were achieved through the development and dissemination of clear clinical protocols and the introduction of auditing and feedback mechanisms.

  • Clinical practice guidelines
  • continuous quality improvement
  • patient outcomes

Statistics from Altmetric.com

Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.