S3283 Reducing Hospital Readmission Rates of Cirrhotics Using Nutrition Counseling

Abstract

INTRODUCTION: There are over 150,000 hospitalizations yearly for decompensated cirrhosis and other related complications with an annual cost around $4 billion. There is an estimated 20–37% 30-day readmission rate for patients with complications of cirrhosis. Malnutrition and sarcopenia occurs in 20-50% of cirrhotics and may lead to infection, encephalopathy, ascites and increased mortality. Per EASL Clinical Practice Guidelines 2019, “..all patients with advanced liver disease, and in particular those patients with decompensated cirrhosis, are advised to undergo a nutritional screen.” In a study by Sriram et al in 2016, a nutrition focused quality improvement program (QIP) led to an absolute reduction of 30-day readmission rate post-QIP of the rate of about 4.7 to 3.9%, which corresponded to a significant relative risk reduction of 19.5% (P = 0.001, n = 174 for GI disease). The purpose of this project is to standardize referrals to dieticians for patients diagnosed with cirrhosis. METHODS: A retrospective chart review was performed on 16 patients with cirrhosis admitted to the academic teaching service in February 2019. Some of the patients received nutrition counseling during their hospitalization. All patients had MELD scores < 20 correlating with a 3-4% mortality in 90-days. The patients were reviewed were followed up until they were readmitted. over a 30 day to > 90-day period for readmissions. RESULTS: Given the small cohort of patients, a qualitative retrospective chart review of 16 patients admitted for cirrhosis related complication was completed. Almost 75% (n = 12) of these patients did not receive nutrition counseling during their hospitalization, while 25% (n = 4) of these patients received nutrition counseling. 62.5% (10/16) of the patients who did not receive nutrition counseling were readmitted within 6 months, 9 of which were readmitted within 30 days 68.8% (11/16) (Figure 2). None of the patients who received nutrition counseling were readmitted (0/4) (P = 0.014). The most common reasons for readmission were ascites (n = 3), bleeding (n = 3), encephalopathy (n = 2), or related complications (n = 2). CONCLUSION: Patients with cirrhosis may benefit from inpatient nutrition counseling. There should be clear definitions of clinicians' role in delivering nutrition care, routine screening of all patients for malnutrition risk factors, and early interventions when risk is identified. More effective utilization of nutrition counseling may lead to lower hospital readmission rates in patients with cirrhosis.Figure 1.: A process flow map demonstrating the policies and procedures relating nutrition counseling for patients with cirrhosis.Figure 2.: Timeline for readmissions in February 2019 of cirrhotic patients during their initial decompensating event.