A novel, nurse-led 'one stop' clinic for patients with liver cirrhosis results in fewer liver-related unplanned readmissions and improved survival

Eric Kalo; Asma Baig; Emily Gregg; Jacob George; Scott Read; Wai-See Ma; Golo Ahlenstiel

doi:10.1186/s12876-023-02986-y

A novel, nurse-led 'one stop' clinic for patients with liver cirrhosis results in fewer liver-related unplanned readmissions and improved survival

BMC Gastroenterol. 2023 Oct 16;23(1):356. doi: 10.1186/s12876-023-02986-y.

Authors

Eric Kalo^{1

2}, Asma Baig², Emily Gregg², Jacob George^{3

4}, Scott Read^{1

2

3}, Wai-See Ma², Golo Ahlenstiel^{5

6

7}

Affiliations

¹ Blacktown Clinical School and Research Centre, School of Medicine, Western Sydney University, 18 Blacktown Road, Blacktown, NSW, 2148, Australia.
² Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, 2148, Australia.
³ Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, 2145, Australia.
⁴ Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, 2145, Australia.
⁵ Blacktown Clinical School and Research Centre, School of Medicine, Western Sydney University, 18 Blacktown Road, Blacktown, NSW, 2148, Australia. g.ahlenstiel@westernsydney.edu.au.
⁶ Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, 2148, Australia. g.ahlenstiel@westernsydney.edu.au.
⁷ Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, 2145, Australia. g.ahlenstiel@westernsydney.edu.au.

Abstract

Objective: Delivering effective secondary preventive and integrated care has the potential to break the revolving-door phenomenon of frequent readmissions in patients with advanced chronic liver disease. To address this, we launched the Care Coordination of Liver Disease (CCoLD) pilot, a novel nurse-led cirrhosis clinic in Western Sydney.

Methods and analysis: Following an index presentation to Blacktown or Mount Druitt hospitals (BMDH), patients (n = 89, matched by age, sex, and MELD-NA) were consecutively either followed up by the CCoLD clinical nurse consultant (intervention cohort) or received standard care (control cohort). Controlled evaluation of the impact of the nurse-led clinic was carried out for a 3-month period including readmission rates, survival, and cost effectiveness.

Results: The inaugural nurse-led clinic led to improvement in patient-level outcomes including a reduction in unplanned liver-related readmissions (2.08% for intervention cohort vs 12.2% for control cohort, p < 0.01), and mortality at 30 days (0% for intervention cohort vs 7.3% for control cohort, p = 0.03). Similar trends were observed at 90 days from index discharge. No deaths were observed in the intervention cohort as compared to the control cohort at 90 days (0% versus 7.3%, p = 0.03), while unplanned liver-related readmissions were 10.41% for the intervention cohort vs 19.5% for the control cohort (p = 0.115). Moreover, time to readmission was significantly longer in the intervention cohort, resulting in an overall cost-effective intervention.

Conclusion: These findings highlight the significant impact of optimised care-coordination. A nurse-led clinic can deliver patient-centred, goal-directed, and cost-effective secondary prevention and care. A multicentre randomised trial for wider evaluation of these findings is warranted.

Keywords: Cirrhosis; Clinic; Mortality; Nurse; Readmissions.

MeSH terms

Female
Humans
Liver Cirrhosis / therapy
Male
Nurse's Role*
Patient Discharge
Patient Readmission*