PWE-35 Improved Outcomes Following the Implementation of a Decompensated Cirrhosis Discharge Bundle

IntroductionDecompensated cirrhosis is a complex disorder with a high mortality rate and as a result re-admissions to hospital are common following discharge. Our aim was to evaluate the impact of implementation of a ‘Decompensated Cirrhosis Discharge Bundle (DCDB)’ and determine whether this improves the provision of evidence-based care and reduces preventable readmissions.MethodsA baseline review of the management of consecutive patients discharged with a diagnosis of decompensated cirrhosis was conducted in 2017 to assess the management of complications including ascites, encephalopathy, varices and alcohol misuse, and to determine readmission rates. Subsequently the DCDB was developed and implemented. Two cycles of evaluation of the impact of the bundle were conducted, the first using a paper version (Nov 2018-Oct 2019) and the second an electronic version (Nov 2020-March 2021).ResultsOverall, 225 patients (63% male; median age 55; median MELD 17; 72% alcohol-related) were reviewed. Clinical and demographic features were similar in the 3 review periods. The overall 30 day readmission rate was 30% (12% potentially avoidable) in baseline review (n=61) and areas for improvement were identified. In the first review following implementation of the DCDB (n=86) only 23 (27%) had a bundle completed. This increased to 69% (31/45) in the second review following implementation of the electronic DCDB. A comparison between patients with and without a DCDB is shown in the table 1. Overall, use of the bundle was associated with improved care across all domains assessed.Abstract PWE-35 Table 1DCDB n=54 No DCDB n=138 P value Alcohol misuse 63% 64% p=0.917 Alcohol team review 85% 66% p=0.044 Thiamine prescribed 91% 85% p=0.552 Community alcohol plan 62% 39% p=0.026 HE related admission 30% 42% p=0.138 Lactulose prescribed 94% 91% p=1.0 Rifaximin prescribed 94% 84% p=0.679 Ascites present 70% 69% p=0.886 Discharge creatinine documented 66% 6% p