Construction and application of an intraoperative nursing quality indicator system for liver transplantation based on the structure-process-outcome model.

OBJECTIVE

To develop and evaluate an intraoperative nursing quality indicator system for liver transplantation based on the structure-process-outcome (SPO) model.

METHODS

A two-phase mixed-methods study was conducted. In phase I, an initial indicator framework was developed through literature review and refined through two rounds of Delphi consultation with 25 experts. The Analytic Hierarchy Process was used to determine indicator weights. In phase II, the system was applied in 128 liver transplant recipients. Patients receiving routine care from January to June 2025 formed the control group (n = 64), while those managed using the indicator system from July to December 2025 formed the intervention group (n = 64). Nursing quality scores, perioperative complications, and surgeon satisfaction were compared.

RESULTS

The final system included 3 first-level, 10 second-level, and 42 third-level indicators, with process indicators receiving the highest weighting (45.6%). Compared with the control group, the intervention group showed significantly higher nursing quality scores, lower rates of intraoperative hypothermia and pressure injuries, and higher surgeon satisfaction scores (all p < 0.05).

CONCLUSION

The SPO-based indicator system improved the standardisation and quality of intraoperative nursing care in liver transplantation and may support perioperative quality improvement in transplant practice.