Smethurst Katherine, Gallacher Jennifer, Jopson Laura, Majiyagbe Titilope, Johnson Amy, Copeman Philip, Mansour Dina, McPherson Stuart
Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
Gastroenterology, Gateshead Health NHS Foundation Trust, Gateshead, UK.
Frontline Gastroenterol. 2021 Dec 15;13(5):409-415. doi: 10.1136/flgastro-2021-102021. eCollection 2022.
Mortality from liver disease is increasing and management of decompensated cirrhosis (DC) is inconsistent across the UK. Patients with DC have complex medical needs when discharged from hospital and early readmissions are common. Our aims were: (1) to develop a Decompensated Cirrhosis Discharge Bundle (DCDB) to optimise ongoing care and (2) evaluate the impact of the DCDB.
A baseline review of the management of patients with DC was conducted in Newcastle in 2017. The DCCB was developed and implemented in 2018. Impact of the DCDB was evaluated in two cycles, first a paper version (November 2018-October 2019) and then an electronic version (November 2020-March 2021). Key clinical data were collected from the time of discharge.
Overall, 192 patients (62% male; median age 55; median model for end-stage liver disease 17; 72% alcohol related) were reviewed in three cycles. At baseline, management was suboptimal, particularly ascites/diuretic management and provision of follow-up for alcohol misuse and 12% of patients had a potentially avoidable readmission within 30 days. After DCDB introduction, care improved across most domains, particularly electrolyte monitoring (p=0.012) and provision of community alcohol follow-up (p=0.026). Potentially preventable readmissions fell to 5% (p=0.055).
Use of a care bundle for patients with DC can standardise care and improve patient management. If used more widely this could improve outcomes and reduce variability in care for patients with DC.
肝病死亡率呈上升趋势，英国各地对失代偿期肝硬化（DC）的管理并不一致。DC患者出院后有复杂的医疗需求，早期再入院很常见。我们的目标是：（1）制定失代偿期肝硬化出院综合方案（DCDB）以优化持续护理，（2）评估DCDB的影响。
2017年在纽卡斯尔对DC患者的管理进行了基线评估。DCCB于2018年制定并实施。DCDB的影响分两个阶段进行评估，首先是纸质版（2018年11月至2019年10月），然后是电子版（2020年11月至2021年3月）。从出院时开始收集关键临床数据。
总体而言，在三个阶段共评估了192例患者（62%为男性；中位年龄55岁；终末期肝病模型中位数为17；72%与酒精有关）。基线时，管理欠佳，尤其是腹水/利尿剂管理以及对酒精滥用的随访安排，12%的患者在30天内出现了可能避免的再入院情况。引入DCDB后，大多数领域的护理得到改善，尤其是电解质监测（p=0.012）和社区酒精随访安排（p=0.026）。可能可预防的再入院率降至5%（p=0.055）。
对DC患者使用护理综合方案可使护理标准化并改善患者管理。如果更广泛地使用，这可能改善结局并减少DC患者护理的变异性。
