Nurse Led Clinics; a Novel Model of Care for Compensated Liver Cirrhosis

Abstract

A nurse-led cirrhosis clinic model for management of stable, compensated cirrhotic patients is practised in our unit since 2013, wherein these patients are reviewed every six months by specialist nurses in community clinics under remote supervision of hepatologists. We evaluated the experiences of patients and healthcare providers involved in the model to understand the acceptability, strengths, and limitations of the model and obtain suggestions to improve. A qualitative design using in-depth interviews was employed, followed by thematic analysis of eight patients, one attending physician both nurse and hospital clinics, four hepatologists, and three experienced specialist nurses running the nurse-led cirrhosis clinic. Patients expressed satisfaction and a good understanding of the nurse-led cirrhosis clinic, preferring it to hospital clinics for better accessibility and the unique nurse-patient relationship. Upskilling and provision of professional care in a holistic manner were appreciated by specialist nurses. The hepatologists expressed confidence and satisfaction, although they acknowledged the difference between the medical training of specialist nurses and hepatologists. The greater availability of hospital clinic time for sick patients was welcomed. Increased

A novel, nurse-led ‘one stop’ clinic for patients with liver cirrhosis results in fewer liver-related unplanned readmissions and improved survival

“…These independent predictors of early readmission can be easily missed without programmes of closer surveillance post discharge such as nurse-led clinics. In addition to improved access, nurse-led clinic can provide at least equal or at times better outcomes compared to standard care with high levels of patient satisfaction and convenience [ 24 , 25 ]. The improved accessibility offered by a cirrhosis nurse-led clinic has improved patient adherence to clinic attendance, translating into improved compliance with clinic appointments, endoscopic and radiological surveillance, earlier escalation of complications, and overall better disease management.…”

Science and Knowledge Development in the Gastroenterology Nursing Specialty: More Than We Could Have Imagined

“…Current nursing interventional research is looking at novel applications for practical support of patients. In gastroenterology nursing, for example, Ramachandran et al (2022) published their analysis of a nurse-led cirrhosis clinic model that has had positive outcomes for stable patients requiring long-term surveillance and support. Wang, Xie, Hou, Sun, and He (2022) used WeChat text messaging to improve bowel preparation outcomes for outpatient colonoscopy.…”