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Novel, nurse-led early postdischarge clinic is associated with fewer readmissions and lower mortality following hospitalisation with decompensated cirrhosis
  1. Benjamin Giles,
  2. Kirsty Fancey,
  3. Karen Gamble,
  4. Zeshan Riaz,
  5. Joanna K Dowman,
  6. Andrew J Fowell,
  7. Richard J Aspinall
  1. Gastroenterology and Hepatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
  1. Correspondence to Dr Richard J Aspinall, Gastroenterology & Hepatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK; r.j.aspinall{at}


Objective Patients hospitalised with decompensated cirrhosis have high rates of early unplanned readmission. Many readmissions are avoidable with secondary preventative strategies, but patients are often readmitted prior to outpatient review. To address this, we established a novel, nurse-led early postdischarge (EPD) clinic delivering goal-directed care for cirrhosis complications and evaluated the impact.

Methods Retrospective cohort study comparing outcomes in 78 patients seen in the EPD clinic with 91 phenotypically matched controls receiving standard, consultant hepatologist care. Follow-up for 12 months from index admission with endpoints including survival, time to readmission, number of readmissions and healthcare burden.

Results Median time to readmission was 51 days in controls and 98 days in the intervention group (p<0.01). The intervention cohort had significantly fewer readmissions at 30 days (12% vs 30%, p<0.01) and 90 days (27% vs 49%, p<0.01) but not significantly at 12 months (58% vs 68%, p=0.16) with an overall reduction in bed day usage of 29%. Mortality for the control group was 4% at 30 days with no deaths in the intervention group. There were significantly fewer deaths in the intervention group at 90 days (5% vs 15%, p<0.05) and 12 months (22% vs 41%, p<0.01).

Conclusions Following an index hospitalisation with decompensated cirrhosis, goal-directed postdischarge care can be effectively delivered by specialist nurses, prior to outpatient review by hepatologists. This model was associated with significantly fewer readmissions, lower bed day usage and a reduced mortality. Our data suggest such models of care deserve wider implementation and further evaluation.

  • cirrhosis
  • ascites
  • hepatic encephalopathy
  • liver
  • portal hypertension

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors BG, KF, KG, ZR, JKD, AJF and RJA contributed to the data collection and proofread the manuscript. BG and RJA analysed the data and wrote the first draft and revised the manuscript. RJA is the guarantor for this study. All of the authors made substantial contributions to the conception and design of the work and the acquisition, analysis and interpretation of data. All contributed to the draft manuscript, revisions and approval of the final version. All have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.