Background and Aims Hepatic Encephalopathy (HE) leads to multiple hospitalizations in liver cirrhosis. This imposes a significant burden on patients caregivers, and the healthcare system. Rifaximin reduces HE recurrence and hospitalizations, but many patients are not able to receive Rifaximin promptly after hospitalizations due to gaps in the prior authorization process and insurance coverage. This study shows the results of the Quality Improvement (QI) project aimed at improving access to Rifaximin by utilization of hospital pharmacy to provide Rifaximin at bedside or soon after hospital discharge with HE. Methods A retrospective analysis of 124 patients admitted to our hospital with recurrent HE was performed. All selected patients had Rifaximin prescribed for the first time during a hospitalization (index hospitalization). Both 30-day and 60-day liver-related hospitalizations were recorded for these patients. 80 patients were included in the intervention group when the hospital pharmacy was notified of the Rifaximin prescription prior to discharge as part of a QI project (Group A). Control (Group-B) group included 44 patients who had admission and were prescribed Rifaximin at discharge, prior to initiation of our QI project. Results The number of patients who had a re-admission after index hospitalization with HE was lower in Group A compared to Group B (48% vs 73%, p=0.002 for re-admission within 30 days; 56% vs 73%, p=0.007 for re-admission within 60 days respectively). Total hospitalizations decreased in Group A (reduced by 32%, and 59% for the 30-day and 60-day time frame, respectively) compared to Group B. The median days to readmission in Group A was 32, compared to 10 in Group B after the index hospitalization. Conclusion Providing Rifaximin to patients with recurrent HE before or soon after discharge from HE-related hospitalization reduced readmission rates for liver-related admissions at our hospital. A significantly higher number of patients did not require early readmission when Rifaximin was provided by the hospital pharmacy. This intervention could lead to lower costs, fewer complications related to frequent hospitalization, and thus reduced healthcare burden.

Background:Despite in ammatory bowel's disease's (IBD) association with hepatobiliary disorders and the use of endoscopic retrograde cholangiopancreatography (ERCP) for both diagnostic and therapeutic evaluation of these diseases, it remains a poorly studied area within the literature. The purpose of this study is to examine the effect of IBD on the occurrence of adverse events (AE) pertaining to ERCP. Methods:This project utilized the National Inpatient Sample (NIS) database, the largest inpatient database in the United States. All patients 18 years or older with and without IBD undergoing ERCP were identi ed from 2008 to 2019. Post-ERCP AEs were analyzed using multivariate logistic or linear regression controlling for age, race, and existing comorbidities using the Charlson comorbidity index (CCI). Results:There was no difference in post-ERCP pancreatitis (PEP) or mortality. IBD patients were also found to have a lower risk of bleeding and decreased length of stay (LOS) despite adjustment for co-morbidities. Subgroup analysis between ulcerative colitis (UC) and Crohn's disease (CD) did not nd any signi cant differences in outcomes. Conclusion:To our knowledge, this is the largest study to date evaluating ERCP outcomes in IBD patients. After adjustment of co-variates, there was no difference in the occurrence of PEP, infections and perforation. IBD patients were less likely to experience post-ERCP bleeding, mortality and LOS.

Background: Despite inflammatory bowel’s disease’s (IBD) association with hepatobiliary disorders and the use of endoscopic retrograde cholangiopancreatography (ERCP) for both diagnostic and therapeutic evaluation of these diseases, it remains a poorly studied area within the literature. The purpose of this study is to examine the effect of IBD on the occurrence of adverse events (AE) pertaining to ERCP. Methods: This project utilized the National Inpatient Sample (NIS) database, the largest inpatient database in the United States. All patients 18 years or older with and without IBD undergoing ERCP were identified from 2008 to 2019. Post-ERCP AEs were analyzed using multivariate logistic or linear regression controlling for age, race, and existing comorbidities using the Charlson comorbidity index (CCI). Results: There was no difference in post-ERCP pancreatitis (PEP) or mortality. IBD patients were also found to have a lower risk of bleeding and decreased length of stay (LOS) despite adjustment for co-morbidities. Subgroup analysis between ulcerative colitis (UC) and Crohn’s disease (CD) did not find any significant differences in outcomes. Conclusion: To our knowledge, this is the largest study to date evaluating ERCP outcomes in IBD patients. After adjustment of co-variates, there was no difference in the occurrence of PEP, infections and perforation. IBD patients were less likely to experience post-ERCP bleeding, mortality and LOS.