studies

214A AASLD ABSTRACTS HEPATOLOGY, October, 2015
13
A simple educational tool for reducing 30-day hospital
readmissions in patients with decompensated cirrhosis
Dennis Kumral, Michael W. Crothers, Stephen H. Caldwell, Zachary
Henry; University of Virginia, Charlottesville, VA
Background: Cirrhosis is a chronic disease with acute on
chronic decompensating events that lead to hospitalization,
similar to congestive heart failure (CHF) and chronic obstructive
pulmonary disease (COPD). While patients with CHF and
COPD have widespread targeted discharge pathways that
help prevent readmissions, patients with cirrhosis have no
standardized discharge programs. We developed a quality
improvement initiative aimed at utilizing a standardized discharge
pathway for patients with cirrhosis. Our goal was to
reduce 30-day readmissions to our inpatient hepatology service
by at least ten percent. Methods: In April 2015 we began a
quality improvement discharge education program for patients
with cirrhosis complicated by either fluid overload or hepatic
encephalopathy. A dedicated hepatology nurse coordinator
performed a teaching session with patients and their families
prior to discharge and provided them with a patient-friendly
cirrhosis management booklet created by the study team. All
patients were provided with a digital scale and pill organizer
if they did not already own one. Within 72-hours of discharge,
a phone call was made to patients to review medications and
reinforce teaching. Patients were monitored for readmission up
to 30 days post discharge as the primary quality outcome. A
control group of cirrhosis patients without a dedicated teaching
program was chosen from hospital discharges during the same
time period one year earlier. Thirty-day readmission rates were
assessed for comparison. Results: A total of 20 patients with
cirrhosis complicated by fluid overload and/or hepatic encephalopathy
went through the discharge pathway and reached
30 days post discharge at the time of this submission. We
identified 25 control patients from the same time period one
year earlier. There was no significant difference in age, gender,
discharge MELD, discharge child pugh score, or length
of stay between the two groups. The 30 day readmission rate
in the study group was 25% compared to 62% in the control
group, p=0.02. This correlates to a relative risk reduction of
60% with a number needed to teach (NNT) of 2.7 to prevent
one 30-day readmission. On multivariate logistic regression
the only significant variable for predicting 30 day readmission
was participating in the educational discharge pathway which
was found to be protective, OR 0.22, p=0.02. Conclusions:
Implementation of a dedicated educational discharge pathway
with detailed teaching of cirrhosis management and a post-discharge
follow-up phone call can reduce 30-day readmissions
for patients with decompensated cirrhosis.
Disclosures:
Stephen H. Caldwell - Advisory Committees or Review Panels: Vital Therapy;
Grant/Research Support: Genfit, Gilead Sciences, Immuron, Hyperion, Immuron,
NGM
The following authors have nothing to disclose: Dennis Kumral, Michael W.
Crothers, Zachary Henry
14
Development of a Model to Predict Post-Surgical
Unplanned Readmissions in Patients with Decompensated
Cirrhosis
Monica Schmidt 1 , Paul H. Hayashi 2 , Alfred S. Barritt 2 ; 1 UNC Liver
Center & Gillings School of Global Public Health, University of
North Carolina Chapel Hill, Chapel Hill, NC; 2 UNC Liver Center,
Chapel Hill, NC
Background:In the U.S., liver cirrhosis is expected to affect more
than 1 million individuals by 2020 and many will require surgery.
Prediction of 30-day readmission will be key in designing
appropriate discharge planning and preventing readmissions.
We developed a predictive model for 30-day readmission that
is specific to patients with decompensated liver cirrhosis undergoing
surgery. Methods:We used the National Surgical Quality
Improvement Program data (NSQIP) from 2011-2013. Patients
with cirrhosis were identified. Predictions were obtained for
the model and the MELD score for comparison. The AUROC,
cut-point, sensitivity/specificity and decision curve analysis
are reported. Results: There were 5,879 patients with 739
readmissions within 30-days (13%). Predictors of 30-day
readmission were insulin dependent diabetes (OR 3.4 CI 1.6-
7.3), discharged home (OR 3.4 CI 1.5-8.7), ASA class 4-life
threatening (OR 4.7 CI 1.8-12.1), and days from surgery to
discharge (OR 0.94 CI 0.91-0.97). The AUROC for the MELD
score was 0.50 while our model reached 0.80 (p