Root Cause Analysis–based Risk Management Nursing Protocol For Patients With Gastric Ulcer

Summary

This protocol describes a root cause analysis-based risk management nursing workflow for hospitalized patients with gastric ulcers, including risk identification, causal analysis, individualized intervention, dynamic reassessment, discharge education, and follow-up.

Abstract

Gastric ulcer is a chronic digestive disorder characterized by recurrence, complications, and reduced quality of life. Although pharmacological treatment remains essential, variability in nursing processes, incomplete risk identification, and insufficient follow-up may hinder recovery and long-term disease control. Root cause analysis (RCA) is a structured quality-improvement method used to identify underlying causes of care-related risks and to guide targeted corrective action. This article describes a reproducible RCA-based risk management nursing workflow for hospitalized patients with gastric ulcers. In this retrospective comparative implementation, 240 patients admitted between January 2021 and December 2024 were identified from hospital records and classified, according to the nursing model documented during hospitalization, into a routine-care group and an RCA-based nursing group, with 120 patients in each group. The workflow includes multidisciplinary team formation, identification of representative nursing risk events, timeline reconstruction, root-cause classification, individualized intervention planning, dynamic inpatient reassessment, discharge education, and structured post-discharge follow-up. Outcome assessment procedures include evaluation of nursing effectiveness, complications, recurrence, patient satisfaction, and quality of life using gastroscopy, hospital records, a structured satisfaction assessment, and the Short Form-36 (SF-36). In this retrospective comparative study, patients managed under the RCA-based workflow showed more favorable outcomes than those receiving routine nursing care. This protocol provides an operational framework for integrating RCA into gastric ulcer nursing practice and may support reproducible risk management in other chronic disease care settings.

Introduction

Gastric ulcer is a common digestive disorder with a multifactorial etiology involving Helicobacter pylori infection, abnormal gastric acid secretion, drug-induced mucosal injury, dietary habits, and psychosocial factors¹. With changes in lifestyle, eating patterns, and stress exposure, peptic ulcer disease continues to impose a substantial clinical burden worldwide². Many patients with gastric ulcer experience persistent abdominal pain, poor appetite, and sleep disturbance, and those who develop complications such as bleeding or perforation often show marked impairment in health-related quality of life

Protocol

All procedures involving human participants were performed in accordance with the ethical standards of the institutional and national research committee and with the Declaration of Helsinki. This retrospective comparative study was approved by the Ethics Committee of Luzhou People’s Hospital (approval no. LLW202601008). De-identified clinical data extracted from hospital records were used for the retrospective review. Written informed consent from patients or their legal representatives was obtained before follow-up contact and questionnaire completion when required by the ethics committee.

1. Identification of eligible patients....

Results

Study-group classification and analysis of the population

The study flow is summarized in Figure 1. A total of 286 candidate cases were initially identified from hospital records during the predefined review period. After screening for gastroscopy-confirmed diagnosis, recording completeness, and applying predefined exclusion criteria, 240 eligible patients were included in the retrospective comparative analysis, with 120 patients .......

Discussion

This study evaluated a root cause analysis (RCA)-based risk management nursing protocol for hospitalized patients with gastric ulcers and compared its documented clinical performance with that of routine nursing care. Under the conditions of this retrospective comparative study, the RCA-based workflow was associated with higher nursing effectiveness, lower complication and recurrence rates, better SF-36 scores, and higher nursing satisfaction. These findings support the practical value of organizing gastric ulcer nursing.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Data abstraction form	Self-developed in this study	N/A	Used for retrospective extraction of baseline, inpatient, and follow-up data
Dynamic risk reassessment sheet	Self-developed in this study	Supplementary Table S3	Used to define reassessment domains and intervention triggers in the RCA-based workflow
Eligibility screening checklist	Self-developed in this study	Supplementary Table S1	Used for retrospective case screening and eligibility confirmation
Endoscopy video processor	Olympus	CV-190	Compatible video processor for endoscopic examination
Gastric ulcer education manual	Self-developed in this study	N/A	Used for discharge education and teach-back support in the RCA-based nursing workflow
Health-related quality-of-life instrument	QualityMetric	SF-36v2 Health Survey	Used for 8-domain quality-of-life assessment
Messaging platform for follow-up communication	Tencent	Weixin / WeChat	Used as an adjunct communication tool for post-discharge follow-up when applicable
Nursing satisfaction questionnaire	Self-developed in this study	Supplementary Table S5	Structured 5-domain, 100-point instrument used for hospital-based satisfaction assessment
Post-discharge follow-up checklist	Self-developed in this study	Supplementary Table S4	Used to standardize telephone or messaging-based follow-up review
RCA event review worksheet	Self-developed in this study	Supplementary Table S2	Used for event logging and root-cause review
Statistical analysis software	IBM	SPSS Statistics 25.0	Used for statistical analysis
Video gastroscope	Olympus	GIF-HQ190	Used for diagnostic and follow-up upper gastrointestinal endoscopy