Effect of Modified Clinical Pathway Guidelines on Congestive Heart Failure Critically Ill Patient's Health Outcomes at Assuit University Hospital, Egypt

Abstract

Literature review cited that, congestive heart failure critically ill patients are suffering from different health problems which might endanger their lives and safety, compromise their quality of life, and burden hospital resources. Critical care nurses play major role together with the other health care team members in integrating and delivering multidisciplinary health care for such group of patients. This care approach can positively been reflected upon patient’s outcomes and other related variables. Therefore, the aim of this study is to investigate the effect of modified clinical pathway guidelines on congestive heart failure critically ill patients' health outcomes. Research hypothesis; critically ill congestive heart failure patients who are subjected to the modified clinical pathway guidelines in addition to the routine hospital care will Show; 1- More hemodynamic stability,2- Lesser exposure to chest pain and dyspnea attacks, 3- Fewer systemic complications, 4- Lesser CCU stay / days and the numbers of re-hospitalizations, 5- Lesser degree of dependent edema and grade of heart failure, and 6 - Report lesser numbers of negative variables than that of a matched control group of patients whom received the routine hospital care only. Quasi-experimental research design was used to conduct this study. Setting; the current study was conducted at the Coronary Care Unit of Assuit University Hospitals, Egypt. Sample; sixty adult male and female critically ill congestive heart failure patients were included in this study and assigned randomly into two equal and matched groups, (study and control of 30 patients each). Tools: Four tools were developed and tested by the investigators. These tools are; I: Congestive heart failure critically ill patient’s assessment sheet, II Congestive heart failure critically ill complications monitoring sheet, III: Congestive heart failure critically ill Patient’s health outcomes assessment sheet, and IV: Modified clinical pathway guidelines variances checklists Congestive heart failure critically ill Patient’s health outcomes assessment sheet. Setting: Coronary Care Unit (CCU) of El-Or man Hospital, Assuit University Hospitals, Egypt. Methods: The researchers trained, participated in coordinating, and supporting the implementation of the clinical pathway guidelines, and then evaluated its effects on the selected congestive heart failure critically ill patients’ health outcomes. Results of this study revealed that, patients in modified clinical pathway guidelines group got significantly lesser chest pain and dyspnea attacks, decreased weight gain, fewer systemic complications; shorter length of hospital stay / days, with lesser negative variables than that of the control group subjects. Thus the complex research hypothesis can be partially supported. Conclusion: Applying modified clinical pathway guidelines could significantly improve patient's health outcomes in congestive heart failure critically ill patients. Recommendations: Clinical pathway care approach needs to be supported and initiated in the CCU at Assuit University Hospitals with furthermore replications of this study and other related studies on a larger probability samples in relation to patient’s health outcomes, safety, and  hospital resources.            

Keywords: Congestive Heart Failure Critically ill patients, Modified Clinical Pathway Guidelines, Clinical Pathway, and Patient's Health Outcomes.