Discharge education can lower risk of readmission in decompensated cirrhosis

SAN FRANCISCO — Risk of readmission within 30 days of discharge lowered by 60% in patients with decompensated cirrhosis who underwent an educational discharge procedure, but lack of commitment from an institution can hinder success, according to a presentation at The Liver Meeting 2015.

“A simple intervention like this does have the potential to work. It really needs support from the system itself to provide the ancillary staff,” Dennis Kumral, MD, internal medicine resident at the University of Virginia, said in his presentation.

Kumral and colleagues hypothesized that a quality improvement initiative that standardized discharge procedure for those patients with cirrhosis would lower the hospital’s readmission rate, which Kumral cited as costing $20,581 per patient for each 30-day readmission.

In April 2015, they implemented an education program for those patients with cirrhosis and either fluid overload or hepatic encephalopathy at the University of Virginia Medical Center.

“These were areas where patient education could make a difference in affecting readmission,” Kumral said.

The program consisted of a study member delivering a teaching session at the bedside with the patients as well as their families before discharge and offering a patient-oriented cirrhosis management booklet created by the study team. Patients also received a digital scale, weight log and pill organizer.

These tools were followed up with a phone call within 72 hours of discharge where mediations were reviewed and the lesson was reinforced.

The patients (n = 20) were monitored for 30 days and a control group (n = 25) was chosen from hospital discharges 1 year prior. The two groups displayed no significant differences in age, gender, discharge MELD, discharge Child Pugh score, or length of stay.

In the study group, the 30-day readmission rate was 25% while that rate was 62% in the control group (P = .02), producing a 60% risk reduction and a “number needed to teach” of 2.7 to prevent one 30-day readmission.

After a multivariate logistic regression, the only significant variable for 30-day readmission was the educational process put in place. It was found to be protective (OR = .22; P = .02).

Yet, when followed out to 5 months, the new cohort of study patients (n = 42) had a 30-day readmission rate of 32.7%, as compared to the control group (n = 130) at 34.8%. The study group mortality rate was 4.9%, as compared to 7.7% in the control group.

“The backbone of our program was our nurse coordinator,” Kumral said, explaining that after the first month of the study, the coordinator was pulled into other directions at the hospital and enrollment in the study suffered. He suggested a dedicated discharge coordinator is necessary for success.

“We would like to implore our health systems to invest finances and try to help with simple interventions like this, which we showed in our first month have the potential to reduce readmissions. Seeing how much each readmission can cost in the long run could save the health systems money,” Kumral said. – by Katrina Altersitz

Reference:

Kumral D, et al. Abstract 13. Presented at: The Liver Meeting; Nov. 13-17, 2015; San Francisco.

Disclosures: Kumral reports no relevant financial disclosures. See the abstract for full list of all other authors’ disclosures.