An Electronic Decision Support Intervention Reduces Readmissions for Patients With Cirrhosis

One of the most costly and frequent causes of hospital readmissions in the United States is hepatic encephalopathy in patients with underlying liver cirrhosis. In this narrative review, we cover current practices in inpatient management, transitions of care, and strategies to prevent hospital readmissions. Bundled approaches using a model such as the “Ideal Transitions of Care” appear to be more likely to prevent readmissions and assist patients as they transition to outpatient care. Numerous strategies have been evaluated to prevent readmissions in patients with hepatic encephalopathy, including technologic interventions, involvement of nonphysician team members, early follow‐up strategies, and involvement of palliative care when appropriate.

Section: Interventions Addressing He Transitions Of Carementioning

confidence: 57%

Section: Interventions Addressing He Transitions Of Carementioning

confidence: 99%

Section: Interventions Addressing He Transitions Of Carementioning

confidence: 99%

Section: Interventions Addressing He Transitions Of Carementioning

confidence: 99%

See 2 more Smart Citations

Hepatic encephalopathy and strategies to prevent readmission from inadequate transitions of care

Rosenstengle

Kripalani

Rahimi

2022

“…Of late, technology, among other measures, is being leveraged to prevent such unwanted and costly HE readmissions using various methodologies with some success. 72,73 One such health information (IT)-based technology intervention is the Patient Buddy App, which is an ongoing multicenter study, to find if IT can be used to decrease readmissions in cirrhosis patients. 73,74 However, such use and acceptance of technology are not limited to cirrhosis only but to other GI diseases also.…”

Section: Readmissions In Cirrhosis and He-role Of Technologymentioning

confidence: 99%

Inadequate practices for hepatic encephalopathy management in the inpatient setting

Shaw

Beyers

Bajaj

2022

Hepatic encephalopathy (HE) is an important complication of decompensated liver disease. Hospital admission for episodes of HE are very common, with these patients being managed by the hospitalists. These admissions are costly and burdensome to the health‐care system. Diagnosis of HE at times is not straightforward, particularly in patients who are altered and unable to provide any history. Precipitants leading to episodes of HE, should be actively sought and effectively tackled along with the overall management. This mandates timely diagnostics, appropriate initiation of pharmacological treatment, and supportive care. Infections are the most important precipitants leading to HE and should be aggressively managed. Lactulose is the front‐line medication for primary treatment of HE episodes and for prevention of subsequent recurrence. However, careful titration in the hospital setting along with the appropriate route of administration should be established and supervised by the hospitalist. Rifaximin has established its role as an add‐on medication, in those cases where lactulose alone is not working. Overall effective management of HE calls for attention to guideline‐directed nutritional requirements, functional assessment, medication reconciliation, patient education/counseling, and proper discharge planning. This will potentially help to reduce readmissions, which are all too common for HE patients. Early specialty consultation may be warranted in certain conditions. Numerous challenges exist to optimal care of hospitalized OHE patients. However, hospitalists if equipped with knowledge about a systematic approach to taking care of these frail patients are in an ideal position to ensure good inpatient and transition of care outcomes.

Missed diagnosis of cirrhosis in the inpatient setting

Amin

Nguyen

Tapper

2022

Self Cite

Cirrhosis accounts for a large number of deaths in the United States and worldwide, leading to an increasing burden on the healthcare system. Cirrhosis is, however, a progressive disease with different potential complications related to liver dysfunction and portal hypertension. Often, patients may present with complications of cirrhosis without having been diagnosed previously. It is pertinent that clinicians recognize these signs to place patients on an appropriate course of management to help delay or avoid further disease progression while avoiding deleterious outcomes and unnecessary utilization. We will discuss the epidemiology of liver disease, cirrhosis, and its complications (hepatic encephalopathy, ascites, and varices). In this study, we will discuss the rationale and impact of missing these diagnoses on the healthcare system and patient.