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Novel, nurse-led early postdischarge clinic is associated with fewer readmissions and lower mortality following hospitalisation with decompensated cirrhosis. | LitMetric

AI Article Synopsis

  • * A study compared outcomes of patients in the EPD clinic (78 patients) with those receiving standard care (91 patients) over 12 months, measuring aspects like survival rates and readmissions.
  • * Results showed that the EPD group experienced longer times before readmission, significantly fewer readmissions within 30 and 90 days, decreased hospital bed usage, and lower mortality rates, indicating that nurse-led care could improve outcomes for these patients.

Article Abstract

Objective: Patients hospitalised with decompensated cirrhosis have high rates of early unplanned readmission. Many readmissions are avoidable with secondary preventative strategies, but patients are often readmitted prior to outpatient review. To address this, we established a novel, nurse-led early postdischarge (EPD) clinic delivering goal-directed care for cirrhosis complications and evaluated the impact.

Methods: Retrospective cohort study comparing outcomes in 78 patients seen in the EPD clinic with 91 phenotypically matched controls receiving standard, consultant hepatologist care. Follow-up for 12 months from index admission with endpoints including survival, time to readmission, number of readmissions and healthcare burden.

Results: Median time to readmission was 51 days in controls and 98 days in the intervention group (p<0.01). The intervention cohort had significantly fewer readmissions at 30 days (12% vs 30%, p<0.01) and 90 days (27% vs 49%, p<0.01) but not significantly at 12 months (58% vs 68%, p=0.16) with an overall reduction in bed day usage of 29%. Mortality for the control group was 4% at 30 days with no deaths in the intervention group. There were significantly fewer deaths in the intervention group at 90 days (5% vs 15%, p<0.05) and 12 months (22% vs 41%, p<0.01).

Conclusions: Following an index hospitalisation with decompensated cirrhosis, goal-directed postdischarge care can be effectively delivered by specialist nurses, prior to outpatient review by hepatologists. This model was associated with significantly fewer readmissions, lower bed day usage and a reduced mortality. Our data suggest such models of care deserve wider implementation and further evaluation.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10935524PMC
http://dx.doi.org/10.1136/flgastro-2023-102489DOI Listing

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