Development of ERCP Care Model: A Transitional Nursing Model in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography, Lampang Hospital

Abstract

Introduction The incidence of biliary and pancreatic diseases has been increasing worldwide, including in Thailand. Endoscopic retrograde cholangiopancreatography (ERCP) is a therapeutic procedure for managing biliary and pancreatic disorders; however, it carries a complication risk of approximately 5–10%, including pancreatitis, bleeding, and infection. The operating theater at Lampang Hospital initiated ERCP services in fiscal year 2023. Since its implementation, challenges have been observed during the pre-, intra-, and post-procedural phases, as well as in cases of unplanned hospital readmission prior to scheduled follow-up. These issues highlight gaps in transitional care for patients undergoing ERCP. Therefore, the researchers developed a transitional nursing care model for patients undergoing ERCP. 

Objective This study aimed to develop a transitional nursing care model for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) at Lampang Hospital. 

Design This Research and Development employed the ADDIE model as the major conceptual framework for developing the transitional nursing care model. The process consisted of four phases: the analysis phase, which involved assessing the situation, identifying problems and obstacles, and determining the needs for transitional nursing care among patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) at Lampang Hospital; the design and development phase, which focused on constructing the model, verifying its quality, and refining its components; the implementation phase, which entailed piloting the model and examining its outcomes in practice; and finally, the evaluation phase, which assessed the effectiveness of the model.

Methodology Phase 1 involved brainstorming sessions on patient care for those undergoing endoscopic retrograde cholangiopancreatography (ERCP) in the operating theater at Lampang Hospital. Participants were divided into two groups: 1) key informants, consisting of six multidisciplinary team members, one gastrointestinal surgeon, one nurse anesthetist, two operating room nurses, one inpatient ward nurse, and one surgical outpatient nurse; and 2) five patient representatives who had undergone ERCP. Data were collected using a personal information questionnaire and semi-structured interviews, which informed the drafting of the initial model. In Phase 2, the draft model was subjected to quality validation by five experts, piloted with ten patients, and subsequently refined to yield a new model entitled the ERCP Care Model. Phase 3 involved implementing the newly developed model. The sample comprised 20 operating room nurses responsible for ERCP patient care and 60 patients scheduled for ERCP, divided equally into control and experimental groups (30 participants each). Sample size was determined using the G*Power program. Research instruments included the ERCP Care Model, developed based on Naylor et al.’s transitional care framework, a nursing practice manual, patient and family educational leaflets, and an ERCP checklist. Data collection instruments consisted of a patient knowledge test (IOC = .80; KR-20 = .75), a nurse knowledge test (IOC = .80; KR-20 = .77), an anxiety assessment scale (Cronbach’s alpha coefficient, α = .87), a complication record form, and a satisfaction questionnaire (IOC = 1.00; α = .81). All instruments were validated by five experts. In this phase, outcomes before and after implementation were compared, including patient and nurse knowledge, patient anxiety, and incidence of complications. Finally, Phase 4 evaluated the model in terms of satisfaction among both patients and nurses. Data collection was conducted between June 2025 and January 2026. Statistical analyses included descriptive statistics, Paired t-test, Independent t-test, Wilcoxon signed-ranks test, and Chi-square test.

Results The situational analysis revealed that ERCP patient care lacked a systematic guideline, patient and family education was inconsistent, team roles were not clearly defined, and post-discharge follow-up was insufficient. Based on these findings, the transitional nursing care model was developed, validated, and refined to yield the ERCP Care Model, which comprises four core components: E: Engagement & Education, providing knowledge and fostering patient and family participation; R: Responsibility & Readiness, defining responsibilities and preparing the multidisciplinary team; C: Continuity of Care, ensuring seamless care throughout the treatment pathway; and P: Patient Well-being & Prevention, promoting health and preventing complications. Following implementation, patients in the experimental group demonstrated significantly higher post-test knowledge scores compared with the control group (M = 14.50, SD = 2.30 vs. M = 10.40, SD = 2.10; p < .01). Among nurses, knowledge scores increased significantly from M = 11.30 (SD = 1.72) to M = 14.00 (SD = 0.97) (Z = -3.983, p < .001). Experimental group had significantly lower anxiety scores than controls (M = 41.33, SD = 4.87 vs. M = 51.17, SD = 5.41; p < .001). Although complication rates were lower in the experimental group (20.00%) compared with the control group (36.67%), the difference was not statistically significant (p = .252). Patient satisfaction with the model was rated at the highest level (M = 4.85, SD = 0.37), consistent with nurse satisfaction (M = 4.81, SD = 0.40).

Recommendations The ERCP Care Model enhanced the quality of patient care by increasing patient knowledge and reducing anxiety, strengthening nurses’ competencies, and achieving high levels of satisfaction among stakeholders. Moreover, it demonstrated a trend toward reducing post-procedural complications. Therefore, the ERCP Care Model should be adopted as a standard nursing practice guideline in operating rooms for patients undergoing ERCP. In addition, it has potential for adaptation to other endoscopic interventions and same-day surgery.