The role of the hospitalist in the continuum of care for patients with hepatic encephalopathy: treatment of inpatient episodes and preventing outpatient recurrence and readmissions

Abstract

: Hepatic encephalopathy (HE) is a common complication of advanced cirrhosis that is seen in the majority of patients at some point. Manifesting as a wide spectrum of neuropsychiatric abnormalities, HE has many consequences; increased morbidity and mortality, bothersome symptoms affecting quality of life and routine activities (e.g., working, driving), substantial caregiver burden, frequent hospital admissions and readmissions and associated economic strains. The manifestations of HE are potentially reversible with medical treatment, frequently in the inpatient setting, and preventable with outpatient maintenance of remission. However, breakdowns across the continuum of care for HE patients are responsible for frequent hospital readmissions; hospitalists, who play a pivotal role in improving the management of HE, can improve these outcomes. The authors are US hepatologists with expertise and experience in managing HE and members of the Chronic Liver Disease Foundation (CLDF), a nonprofit 501(c)(3) educational organization dedicated to raising awareness of liver disease. The goals of this article are to provide a thorough review of HE; to describe how HE is currently managed and identify ways to improve diagnosis and treatment; to review the role of the hospitalist in managing and preventing HE episodes; and to provide strategies to reduce hospital readmissions and improve outcomes.