Optimization of nursing care for patients with acute intestinal obstruction using dedicated multidisciplinary team

Abstract

BACKGROUND

Acute intestinal obstruction is a common surgical emergency with high mortality, requiring efficient multidisciplinary collaboration to improve outcomes.

AIM

To explore the optimization of nursing pathways for patients with acute intestinal obstruction using the multidisciplinary team (MDT) model.

METHODS

A total of 176 patients with acute intestinal obstruction admitted to the Emergency Department of our hospital between December 2023 and February 2025 were randomly divided into a control group (n = 88) and an intervention group (n = 88) using a random number table. The control group received routine emergency nursing interventions, whereas the intervention group received emergency nursing pathway interventions under the MDT model. The groups were compared in terms of emergency treatment efficiency, improvement of clinical symptoms, 36-Item Short Form Health Survey (SF-36) scores, nursing satisfaction, and early (within 72 hours) intestinal obstruction–related complications-specifically, electrolyte disturbance, strangulated obstruction, and intestinal necrosis/perforation.

RESULTS

The intervention group had significantly shorter triage, condition assessment, and emergency treatment times (all P < 0.001), faster relief of abdominal pain and vomiting, and earlier return of bowel function (all P < 0.001). The rate of early complications was lower in the intervention group (2.27% vs 10.23%, P = 0.029). Nursing satisfaction was higher (96.59% vs 81.82%, P = 0.002), and post-intervention SF-36 scores were significantly higher (P < 0.05).

CONCLUSION

The MDT-based emergency nursing pathway improves emergency efficiency, relieves clinical symptoms, enhances quality of life and satisfaction, and reduces early intestinal obstruction–related complications in patients with acute intestinal obstruction.

Key Words: Acute intestinal obstruction; Emergency care; Multidisciplinary team model; Nursing pathway; Collaborative care

Core Tip: This study demonstrates that implementing a multidisciplinary team (MDT) model in the emergency nursing pathway for patients with acute intestinal obstruction significantly improves emergency response efficiency, accelerates symptom relief, enhances patients’ quality of life, and increases nursing satisfaction. A 15-minute MDT huddle involving emergency, nursing, radiology, surgery, and laboratory departments shortens key process times and reduces early complications such as electrolyte disturbance, strangulation, or necrosis within 72 hours.

INTRODUCTION

Acute intestinal obstruction is one of the most common causes of acute abdomen in clinical practice, primarily occurring in the rectal and sigmoid colon regions. The condition progresses rapidly and can easily lead to severe complications such as intestinal necrosis, perforation, and infectious shock, thereby significantly increasing the risk of patient mortality. Therefore, it warrants close clinical attention[1,2]. In recent years, with advances in clinical diagnostic and therapeutic technologies, the outcomes of patients with acute intestinal obstruction have improved significantly. Nevertheless, implementing reasonable and effective nursing interventions during the early emergency treatment stage remains of great clinical importance[3].

The multidisciplinary team (MDT) model is a cross-departmental team established on the basis of professional knowledge and competencies. Its goal is to transform the traditional individualized, experience-based nursing model into a modern, team-based approach characterized by collaborative decision-making between medical and nursing staff. The MDT model is increasingly applied in clinical nursing practice and has been shown to improve nursing quality and patient prognosis[4-6]. According to a previous study[7], institutions with adequate resources are recommended to establish a “green channel” for acute intestinal obstruction, forming an MDT that includes the emergency, radiology, intensive care, and surgery departments to ensure integrated diagnosis and treatment within 6 hours. However, a standardized MDT-based quality management system for emergency nursing of acute intestinal obstruction has not yet been established in clinical practice, and effective reference guidelines are still lacking.

Therefore, this study analyzed the application of the MDT model in emergency nursing care for patients with acute intestinal obstruction, aiming to provide a scientific reference for the development of effective nursing strategies.

MATERIALS AND METHODS

General information

A total of 176 patients with acute intestinal obstruction admitted to the Emergency Department (ED) of our hospital between December 2023 and February 2025 were enrolled in this study. They were randomly divided into a control group (n = 88) and an intervention group (n = 88) using a random number table.

Inclusion criteria: (1) Patients who met the clinical diagnostic criteria for acute intestinal obstruction as outlined in the Chinese Expert Consensus on the Diagnosis and Treatment of Small Bowel Obstruction[8]: Typical clinical manifestations such as acute abdominal pain, distension, nausea/vomiting, or absence of flatus and stool; physical examination findings of abdominal distension with hyperactive or absent bowel sounds; erect abdominal radiography or computed tomography (CT) showing dilated intestinal loops with air-fluid levels (CT is preferred, particularly when demonstrating a “transition zone”); laboratory evidence of inflammation or ischemia, including elevated white blood cell count, elevated lactate, or electrolyte disturbances. If imaging unequivocally identifies the site and degree of obstruction, the diagnosis is confirmed when any two of items (1), (2), and (4) are satisfied; (2) First-time emergency visits and admissions; (3) Patients with clear consciousness and the ability to cooperate with condition assessment; and (4) Informed consent obtained.

Exclusion criteria: (1) Patients with other types of acute abdominal conditions, such as acute cholecystitis; (2) Patients with malignant tumors of the digestive system; (3) Patients with severe autoimmune or cardiovascular/cerebrovascular diseases; (4) Patients with severe organic dysfunction of vital organs such as the heart or lungs; and (5) Patients with serious mental illness or cognitive impairment.

Control group

Patients received routine emergency nursing care. Upon arrival, the responsible nurse assisted the emergency physician in monitoring and managing the patient’s condition and supported necessary examinations such as electrocardiography, blood sampling, and abdominal CT. Based on the examination results and physician’s orders, specialized nursing care was provided, including gastrointestinal decompression, pain management, and complication prevention. Standard handover procedures were followed during department transfers.

Intervention group

Patients received emergency nursing pathway interventions under the MDT model, which included the following.

Formation of the MDT nursing team: The team consisted of the emergency head nurse (team leader), five responsible nurses, two emergency physicians, one radiology technician, one general surgeon, and one laboratory physician. The head nurse was responsible for specialized training, supervision of nursing processes, and quality evaluation. Responsible nurses implemented the care plans. Emergency and surgical physicians assessed patients’ conditions and made treatment decisions. Radiology and laboratory physicians conducted and interpreted relevant examinations. All members had ≥ 5 years of experience in their respective fields and completed systematic training (four sessions, 40-50 minutes each) covering the clinical features of acute intestinal obstruction, key treatment and nursing points, emergency skills, and the MDT concept and implementation. All members passed role-playing assessments.

MDT-based emergency nursing pathway: (1) Optimizing triage (1-2 minutes): Upon arrival, vital signs were measured immediately. Nurses collected medical history data, including onset time, triggers, primary symptoms (abdominal pain, vomiting, abdominal distension, and altered consciousness), and recorded Modified Early Warning Score (MEWS) values. The “Emergency Duty WeChat Workgroup” was used to notify relevant departments; (2) Emergency interventions (5-10 minutes): After triage, the ED nurse was required to post the patient’s MEWS score, chief complaint, and vital signs in the “Emergency Duty WeChat Workgroup” within 1 minute and tag the ED physician, radiologist, general surgeon, and laboratory physician. The ED physician was required to reply with a preliminary assessment within 3 minutes. Radiology confirmed the CT appointment time and opened the green channel within 5 minutes of the request. The laboratory ensured that stat blood work was completed and results uploaded to the cloud within 10 minutes. If surgical consultation was required, the general surgeon was required to arrive in the resuscitation bay within 8 minutes of notification for an on-site discussion; (3) Rapid completion of tests (15 minutes): Physicians promptly ordered laboratory and imaging tests. Nurses reviewed the orders and accompanied patients through the green channel to expedite testing. Radiology and laboratory physicians analyzed results and uploaded them to the cloud platform and WeChat workgroup for physician review; (4) Development of treatment plan (15 minutes): After test completion, the MDT team held a meeting to discuss findings and formulate individualized treatment and nursing plans. Nurses communicated the plan and precautions to the patient’s family and obtained informed consent; (5) Specialized nursing care (15 minutes): For abdominal pain, patients were guided in deep-breathing and relaxation exercises, and gentle abdominal massage was provided. Pain relief medications were administered as necessary. For vomiting: Nurses assessed the frequency, volume, and characteristics of vomiting, helped patients assume a semi-recumbent or lateral position to prevent aspiration, and performed gastrointestinal decompression and fluid therapy as prescribed. Psychological support: A strong nurse-patient relationship was established. Emotional changes were closely monitored. Patients were encouraged to express concerns, and nurses provided psychological support, helped identify causes of negative emotions, and taught breathing relaxation techniques to improve treatment compliance; (6) Resolution of decision discrepancies: When diagnostic or therapeutic conflicts arose, the ED head nurse (team leader) immediately convened a “5-minute rapid consensus huddle”. The ED physician, general surgeon, and radiologist joined a WeChat video call, based decisions on current evidence (e.g., 2023 Chinese Expert Consensus on Small-Bowel Obstruction), and voted. The ED head nurse retained veto power to safeguard patient safety. If disagreement persisted, the case was escalated within 30 seconds to the hospital administrator on call, who activated a second-tier expert panel [including the intensive care unit (ICU) director] for remote consultation; (7) Quantified information-transfer metrics: WeChat responsiveness: Daily back-end data exports ensured an initial physician reply within ≤ 3 minutes (pilot data, December 2024: Mean 2.1 minutes). CT booking confirmation: The acceptable delay rate was < 5% (actual delay: 3 of 176 cases). Cloud report synchronization: After laboratory results were uploaded, automatic WeChat reminders achieved a 100% physician read rate (verified via back-end logs). Critical values: Laboratory values such as lactate > 4 mmol/L triggered additional phone calls to ensure zero omissions; and (8) Replicability toolkit: Standardized communication template: All specialties used the Subjective-Objective-Assessment-Plan format for every WeChat message to reduce ambiguity. Role cards: Each discipline appointed one 24/7 online liaison (roster updated quarterly) so that other institutions could rapidly identify responsible personnel when replicating the pathway.

Observation indicators

Emergency efficiency: Triage time, assessment time, and emergency treatment time were recorded.

Improvement in clinical symptoms: Time to relief of abdominal pain and vomiting, as well as time to first anal exhaust and defecation, were recorded.

Quality-of-life scores: Scores were assessed before and after the intervention (on the day of discharge) using the 36-Item Short Form Health Survey (SF-36)[9], which includes eight dimensions scored on a scale of 0-100. Higher scores indicate better quality of life.

Complication rate: The incidence of complications such as intestinal necrosis and perforation during emergency treatment was recorded.

Patient nursing satisfaction: Satisfaction with emergency procedures and efficiency was evaluated using a self-developed questionnaire, classified into four levels (very satisfied, satisfied, neutral, dissatisfied). The total satisfaction rate was defined as the sum of the “very satisfied” and “satisfied” categories. The self-developed Acute Intestinal Obstruction Emergency Nursing Satisfaction Questionnaire was finalized through two rounds of Delphi consultation and comprised 20 items across four dimensions. In a pilot sample of 60 patients, Cronbach’s α was 0.93, test-retest reliability was r = 0.91, the item-level content validity index ranged from 0.83 to 1.00, and the scale-level content validity index average was 0.95. Exploratory factor analysis yielded a Kaiser-Meyer-Olkin value of 0.89, with 74.6% cumulative variance explained; confirmatory factor analysis showed a comparative fit index of 0.96 and root mean square error of approximation of 0.05. These psychometric properties indicated satisfactory reliability and validity, supporting its use in this study.

Statistical analysis

Statistical analysis was performed using SPSS version 26.0. Measurement data conforming to a normal distribution were expressed as mean ± SD. Independent-samples t tests and paired-samples t tests were used for between-group and within-group comparisons, respectively. Categorical data were expressed as n (%), and comparisons between groups were conducted using the χ² test. A P value < 0.05 was considered statistically significant.

RESULTS

Baseline characteristics of patients

In the control group, there were 48 males and 40 females, aged 19-95 years (mean, 66.78 ± 14.46 years). In the intervention group, there were 52 males and 36 females, aged 18-89 years (mean, 64.41 ± 16.18 years). No statistically significant differences were found in baseline data between the two groups (P > 0.05), indicating comparability. This study was approved by the hospital ethics committee.

Comparison of emergency response efficiency between the two groups

Compared with the control group, the intervention group had significantly shorter triage time, condition assessment time, and emergency treatment time, with statistically significant differences (P < 0.05), as shown in Table 1.

Table 1 Comparison of emergency treatment efficiency between the two groups (mean ± SD).

Group	n	Time of triage (minutes)	Condition assessment time (minutes)	Time to emergency treatment (hours)
Control group	88	3.86 ± 0.63	8.69 ± 2.82	3.43 ± 0.76
Intervention group	88	2.75 ± 0.56	6.21 ± 2.07	2.69 ± 0.48
t		12.353	6.650	7.723
P value		< 0.001	< 0.001	< 0.001

Comparison of clinical symptom improvement between the two groups

Compared with the control group, the intervention group had significantly shorter times to relief of abdominal pain and vomiting, as well as to first anal exhaust and defecation. These differences were statistically significant (P < 0.05), as shown in Table 2.

Table 2 Comparison of clinical symptom improvement between the two groups (mean ± SD).

Group	n	Abdominal pain relief time (hours)	Vomiting relief time (hours)	Time to first flatus (hours)	Time to first defecation (hours)
Control group	88	4.97 ± 1.22	6.45 ± 2.28	10.63 ± 3.15	17.33 ± 4.14
Intervention group	88	3.25 ± 1.03	5.03 ± 2.10	8.84 ± 3.21	14.57 ± 3.66
t		10.106	4.297	3.734	4.685
P value		< 0.001	< 0.001	< 0.001	< 0.001

Comparison of quality-of-life scores between the two groups

After the intervention, both groups demonstrated increased SF-36 scores compared with baseline. Furthermore, the intervention group had significantly higher post-intervention scores than the control group (P < 0.05), as shown in Table 3 and Supplementary Table 1.

Table 3 Comparison of quality-of-life scores between the two groups (mean ± SD, score).

Group	n	Physical function		Role-physical		Vitality		General health
		Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention
Control group	88	54.30 ± 4.70	74.26 ± 5.32a	66.42 ± 3.91	82.08 ± 4.79a	61.38 ± 4.42	75.30 ± 4.76a	67.43 ± 4.92	80.43 ± 3.45a
Intervention group	88	54.51 ± 4.77	77.43 ± 5.81a	66.50 ± 4.02	85.66 ± 5.21a	61.51 ± 4.49	78.72 ± 5.03a	67.65 ± 4.98	83.56 ± 3.69a
t		0.294	3.775	0.134	4.745	0.194	4.633	0.295	5.812
P value		0.769	< 0.001	0.894	< 0.001	0.847	< 0.001	0.769	< 0.001

^aP < 0.05 vs same group before intervention.

Comparison of complication rates between the two groups

The complication rate in the intervention group was 2.22%, significantly lower than the 10.00% observed in the control group. This difference was statistically significant (P < 0.05), as shown in Table 4.

Table 4 Comparison of the incidence of complications between the two groups, n (%).

Group	n	Electrolyte disturbances	Strangulated intestinal obstruction	Enterobrosis	Total
Control group	88	4 (4.55)	3 (3.41)	2 (2.27)	9 (10.23)
Intervention group	88	1 (1.14)	1 (1.14)	0 (0.00)	2 (2.27)
χ2					4.752
P value					0.029

Comparison of nursing satisfaction between the two groups

The nursing satisfaction rate in the intervention group was 95.56%, higher than the 80.00% in the control group. This difference was statistically significant (P < 0.05), as shown in Table 5.

Table 5 Comparison of nursing satisfaction between the two groups, n (%).

Group	n	Very satisfied	Satisfied	Neutral	Dissatisfied	Overall satisfaction rate
Control group	88	32 (36.36)	18 (20.45)	22 (25.00)	16 (18.18)	72 (81.82)
Intervention group	88	39 (44.32)	30 (34.09)	16 (17.78)	3 (3.41)	85 (96.59)
χ2						9.971
P value						0.002

DISCUSSION

Acute intestinal obstruction is a gastrointestinal disorder characterized by varying degrees of blockage within the intestinal tract, which restricts the passage of intestinal contents[10,11]. The pathogenesis of acute intestinal obstruction has not been fully elucidated, although most scholars believe it is closely associated with factors such as congenital anatomical abnormalities, intestinal inflammation, and tumor dissemination[12-14]. As a result of these factors, patients commonly present with typical symptoms such as abdominal distension, abdominal pain, and vomiting, and in severe cases may develop intestinal necrosis and other life-threatening complications. Previous studies have shown that timely and effective emergency care can significantly reduce mortality among patients with acute intestinal obstruction[15].

However, traditional emergency nursing has mainly focused on the disease itself while often neglecting the psychological needs of patients and their families. These interventions tend to be relatively simplistic, with each department operating independently and lacking communication and information sharing. Consequently, nursing processes frequently lack standardization, specificity, and foresight, thereby limiting the overall effectiveness of interventions[16,17]. In response, the National Health Commission of the People’s Republic of China issued the Action Plan for Comprehensive Improvement of Medical Quality (2023-2025), which advocates a patient-centered approach and the promotion of multidisciplinary treatment models, offering new directions for optimizing clinical nursing management[18].

The MDT model is an integrated nursing intervention that promotes the effective utilization of medical and nursing resources through interdisciplinary collaboration. It enables comprehensive and objective assessments of patients’ physical, psychological, and social needs, thereby providing diverse and personalized nursing services and achieving the overall goal of patient-centered care[19,20]. In recent years, the MDT model has been widely applied in clinical nursing for intensive care units, trauma orthopedics, and cardiovascular and cerebrovascular diseases, with favorable outcomes[21-23]. Furthermore, several studies have reported that the MDT model facilitates the development of standardized nursing procedures and seamless management across different stages of care, contributing to the establishment of a robust quality management system for nursing practice[24,25].

In this study, after implementation of the MDT-based emergency nursing pathway, the intervention group demonstrated significantly shorter triage, assessment, emergency treatment, and symptom relief times compared with the control group, along with a lower incidence of complications. These findings indicate that the MDT-based emergency nursing pathway enhances emergency efficiency, facilitates more effective relief of clinical symptoms, and reduces the risk of complications in patients with acute intestinal obstruction. This effect may be attributed to several key factors: (1) The MDT team comprised professionals from multiple departments involved in diagnosis and treatment. Each member contributed unique expertise, ensuring clearly defined roles and coordinated collaboration throughout the care process. This addressed the lack of interdepartmental cooperation in traditional emergency workflows and enabled rational resource allocation and efficient, comprehensive emergency measures; (2) The MDT approach promoted information sharing and communication among team members, allowing timely and accurate understanding of patient conditions and needs. This supported the development of optimal rescue plans, including assessment, emergency interventions, diagnostic testing, treatment planning, and specialized nursing care, all of which contributed to symptom relief and recovery; and (3) Through interprofessional collaboration, the MDT model leveraged the strengths of each specialty, compensated for the limitations of single-specialty care, and facilitated rapid adaptation to changes in patient conditions-thereby minimizing adverse events and reducing complication rates[26,27].

Furthermore, this study found that the intervention group had significantly higher nursing satisfaction and SF-36 quality-of-life scores after the intervention compared with the control group. These results indicate that the MDT-based emergency nursing pathway not only improves clinical outcomes but also enhances patients’ quality of life and satisfaction with nursing care. The main reasons for these improvements are as follows: The MDT model emphasized close collaboration among professionals across specialties. Multidisciplinary discussions and shared expertise facilitated the development of tailored treatment and nursing plans, ensuring effective treatment and targeted nursing interventions. This accelerated symptom relief and promoted early return to normal life, thereby improving patients’ quality of life. In addition, the MDT team established in this study included multiple departments with clearly defined roles and responsibilities. Specialized management ensured meticulous execution of nursing care, while mutual learning and collaboration addressed the limitations of single-department interventions. This significantly improved the overall quality and efficiency of nursing care in the Emergency Department, ensuring continuous, high-quality care throughout the patient’s treatment journey and ultimately enhancing patient satisfaction[28].

Although the MDT nursing pathway requires additional multidisciplinary staffing and communication costs, the marked reductions in emergency department dwell time and overall length of stay, together with a lower complication rate, translate into direct savings in bed-day charges and avoidance of costly reoperations and ICU admissions. A preliminary estimate suggested a net saving of 1200-2800 yuan per patient, outweighing the incremental MDT expenditure and yielding superior short-term cost-effectiveness. A formal time-driven activity-based costing analysis is warranted for definitive validation.

CONCLUSION

In conclusion, the MDT-based emergency nursing pathway significantly improved emergency response efficiency, facilitated relief of clinical symptoms, enhanced patients’ quality of life and satisfaction with care, and reduced complication rates in patients with acute intestinal obstruction. However, the relatively small sample size in this study may limit the generalizability of the findings. Therefore, future large-scale, multicenter studies are needed to further refine and validate the MDT-based emergency nursing pathway.