The effectiveness of clinical pathway‐directed care on hospitalisation‐related outcomes in patients with severe traumatic brain injury: A quasi‐experimental study

Mohamed, Warda Ramadan Abouzeid; Leach, Matthew; Reda, Nagwa; Abd‐Ellatif, Mohammad Mohamed; Mohammed, Moghniuddin; Abdel-Aziz, Mervat Anwar

doi:10.1111/jocn.14194

Cited by 8 publications

(14 citation statements)

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“…At the same time, there are also a series of problems, such as weak pertinence, incoherent time, single mode, and inappropriate method [ 4 ]. As a standard nursing mode of clinical norms, clinical pathway nursing is a relatively mature operation system, which has been clinically used in the nursing of a variety of diseases and achieved quite significant application effects [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Effect Analysis of Clinical Pathway Nursing Combined with Humanized Nursing in Cerebral Infarction

Xiao

2022

Computational Intelligence and Neuroscience

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Objective. To make the application effect of clinical pathway nursing combined with humanized nursing clear in cerebral infarction. Methods. Hundred patients who suffered from cerebral infarction had been hospitalized in our hospital and they become our study objects. By means of the random number table, they were separated into 50 cases both in the control group and in the observation group. The control group accepted the routine nursing, and the observation group accepted the clinical pathway nursing mixed with humanized nursing. The followings were compared including the hospitalization expenses and length of stay, National Institutes of Health Stroke Scale (NIHSS), Barthel index rating scale (BI), Fugl-Meyer Assessment (FMA), and the incidence of complications and recurrence rate. A comparison was made between the two groups about satisfaction with nursing. Results. In contrast with the control group, the treatment expenses and length of stay in the observation group were considerably reduced ( P < 0.05 ). In contrast, before nursing, the NIHSS marks of the two groups decreased considerably after nursing, and the scores of BI and FMA increased considerably, the NIHSS scores of the observation group were considerably lower than those of the control group, and the scores of BI and FMA were considerably higher than those of the control group ( P < 0.05 ). In contrast with the control group (44.00%, 12.00%), the incidence of complications (22.00%) and recurrence rate (2.00%) in the observation group were considerably lower ( P < 0.05 ). In contrast with the control group (72.00%), the satisfaction of nursing in the observation group (96.00%) was considerably higher ( P < 0.05 ). Conclusion. The application effect of clinical pathway nursing combined with humanized nursing in cerebral infarction is significant. It can not only effectively reduce hospitalization expenses and hospitalization time, improve neurological function, ability of daily living, and limb motor function but also reduce complications and recurrence and improve patients’ satisfaction with nursing, which has a high clinical reference value.

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Section: Introductionmentioning

confidence: 99%

Effect Analysis of Clinical Pathway Nursing Combined with Humanized Nursing in Cerebral Infarction

Xiao

2022

Computational Intelligence and Neuroscience

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“…This revealed papers relevant to the minor HI patients, but no articles related to high-risk HI patients in ED. I did find some papers with high-risk HI patients management based for critical care 7. Adding key words “clinical pathways” and “head injury” on PubMed did reveal one study which discussed utilisation of a clinical pathway and improving the quality of care 8.…”

Section: Introductionmentioning

confidence: 99%

Project to improve the management of the head injury patients presenting to the emergency department

Hassan,

Naveed,

Khan

2024

BMJ Open Qual

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IntroductionAt Sandwell General Hospital, there was no risk stratification tool or pathway for head injury (HI) patients presenting to the emergency department (ED). This resulted in significant delays in the assessment of HI patients, compromising patient safety and quality of care.AimsTo employ quality improvement methodology to design an effective adult HI pathway that: ensured >90% of high-risk HI patients being assessed by ED clinicians within 15 min of arrival, reduce CT turnaround times, and aiming to keep the final decision making <4 hours.MethodsSWOT analysis was performed; driver diagrams were used to set out the aims and objectives. Plan-Do-Study-Act cycle was used to facilitate the change and monitor the outcomes. Process map was designed to identify the areas for improvement. A new HI pathway was introduced, imaging and transporting the patients was modified, and early decisions were made to meet the standards.ResultsData were collected and monitored following the interventions. The new pathway improved the proportion of patients assessed by the ED doctors within 15 min from 31% to 63%. The average time to CT head scan was decreased from 69 min to 53 min. Average CT scan reporting time also improved from 98 min to 71 min. Overall, the average time to decision for admission or discharge decreased from 6 hours 48 min to 4 hours 24 min.ConclusionsFollowing implementation of the new HI pathway, an improvement in the patient safety and quality of care was noted. High-risk HI patients were picked up earlier, assessed quicker and had CT head scans performed sooner. Decision time for admission/discharge was improved. The HI pathway continues to be used and will be reviewed and re-audited between 3 and 6 months to ensure the sustained improvement.

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“…The majority of TBIs are related to motor vehicle accidents. Moderate and severe TBI accounted for 17.2% of all TBI presentations, and often necessitate admission to the intensive care unit (ICU) (Mohamed et al, 2018 ). Following severe TBIs, survivors often demonstrate a period of unconsciousness characterized by an inability to experience and interact with the environment.…”

Section: Introductionmentioning

confidence: 99%

“…Family engagement is a vital aspect of sensory stimulation for comatose patients following TBI, but research is scarce so far in the Egyptian context. In Egypt, several studies have been investigating the effect of sensory stimulation on improving TBI patients' level of consciousness (Mohamed et al, 2018 ; Mohammed & Hassane, 2017 ). However, little is known about the effectiveness of family members as the source of sensory stimulation in patients following TBI (Zuo et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Outcomes of family‐centred auditory and tactile stimulation implementation on traumatic brain injured patients

et al. 2022

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Aim To determine the outcomes of Family‐centred Auditory and Tactile Stimulation Implementation on Traumatic Brain Injured Patients in Egypt. Background Family engagement in the care of their relatives in the Intensive care units is limited due to patients' life‐threatening conditions, in addition to the use of high technology in these settings. Auditory and tactile sensory stimulations are among the diverse sensory stimulations that have received more attention in brain injured patients than other senses as being considered safe, and effective measures. Design A Quasi‐experimental design was used to test the hypotheses of this study. Methods A convenience sample of 60 adult patients suffering from Traumatic Brain Injury and admitted to the intensive care units of two University Hospitals in Egypt was included in the study. Patients were assigned into two equal groups: control and study groups (30 patients each). The auditory and tactile stimulations were provided by trained family members, once daily for 2 weeks for the study group. Whereas routine communication was provided by the family of traumatic brain injured patients in the ICU for the control group. Two tools were used for data collection; tool one, the “Glasgow Coma Scale” to assess patient's level of consciousness, and tool two the “Physiological Adverse Events Assessment” to monitor patients for the occurrence of physiological adverse events. Data collection: January to October 2019. Results The implementation of an organized auditory and tactile stimulation by trained family members is associated with highly statistically significant positive effects . Patients in the study group showed a higher mean of consciousness, lower incidence rate of physiological adverse events, and a lower mean duration of ICU stay. Conclusions Implementation of an organized auditory and tactile stimulation by trained family members enhanced the consciousness level of comatose Traumatic Brain Injured patients, decreased the occurrence of physiological adverse events, and ICU length of stay. Thus, it is recommended for use in the daily routine nursing care of comatose Traumatic Brain Injured patients. Relevance to Clinical Practice This study gives a deeper understanding of how family engagement in the care of their critically ill relative enhances their recovery and improve their level of consciousness.

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The effectiveness of clinical pathway‐directed care on hospitalisation‐related outcomes in patients with severe traumatic brain injury: A quasi‐experimental study

Abstract: The provision of clinical pathway-directed care in a trauma ICU may offer benefits to the patient, family and institution beyond that provided by usual care.

Cited by 8 publications

References 40 publications

Effect Analysis of Clinical Pathway Nursing Combined with Humanized Nursing in Cerebral Infarction

Effect Analysis of Clinical Pathway Nursing Combined with Humanized Nursing in Cerebral Infarction

Project to improve the management of the head injury patients presenting to the emergency department

Outcomes of family‐centred auditory and tactile stimulation implementation on traumatic brain injured patients

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