Main Factors Influencing the Quality of Care for Patients with Biliary Pathology on the Secondary Level

• Main Authors: Yu.M. Stepanov, І.Yu. Skirda
• Format: Article
• Language: English
• Published: Publishing House Zaslavsky 2014-04-01
• Series: Gastroenterologìa
• Subjects: hospital size; endoscopic gall drainage; acute cholangitis; clinical outcomes
• Online Access: http://gastro.zaslavsky.com.ua/article/view/81941
• ISSN: 2308-2097; 2518-7880

Our aim was to determine the factors influencing the clinical outcome in inpatient care for the patients with the biliary system diseases. This study demonstrated a relationship between the hospital size and clinical outcome of endoscopic drainage for acute cholangitis. It was found that the stay of patients in high volume hospitals was shorter (26.8 ± 22.6 days in the low volume hospitals against 23.3 ± 21.5 and 19.7 ± 17.2 days in high volume and average volume hospitals, р < 0.001). There were also registered less drainage complications (5.6 % in low volume hospitals against 4.3 % in the secondary hospitals and 3.2 % in high volume hospitals, р < 0.001). Endoscopic drainage of gall, endoscopic retrograde cholangiopancreatography and nasobiliary drainage were found to be useful in biliary decompression. The experience of endoscopists performing effective endoscopic gall drainage, and sufficient resources in high volume hospitals are associated with better clinical outcome of endoscopic surgery for acute cholangitis. The elderly patients with severe comorbidities the risk of complications increased due to those interventions. Endoscopic interventions require highly skilled team that consists of endoscopists and other professionals, including recreation therapists. These professionals typically work in high volume hospitals and can provide interdisciplinary medical care that largely improves clinical outcomes.