A0486 - Relevance of Post-Hospital Discharge Appointments in Patients With Liver Disease

Priya Varghese, MD¹, Kathy Williams, MD¹, Supriya Pradhan, MD¹, Justin Mahr, PA-C¹, Simona Rossi, MD¹, Victor Navarro, MD^2
1Albert Einstein Medical Center, Philadelphia, PA; ²Einstein Healthcare Network, Jefferson Health System, Philadelphia, PA

Introduction: Post-hospital discharge (PHD) clinics aim to prevent readmissions and cut healthcare costs. This is important in patients with liver disease who require close monitoring of labs, symptoms and complications. We anticipate that by mitigating hospital necessitating treatments, PHD appointments will reduce readmission rates.

Methods: A retrospective chart review was performed of 258 patients scheduled in the post-discharge hepatology clinic, in our urban liver transplant center, between September 2020 and December 2021. We reviewed the 30-day readmission rate for patients who attended the appointments compared to patients who did not (NS). We determined the impact these visits had on preventing readmission risk. Interventions such as medication adjustments and scheduling of outpatient paracentesis were among the metrics reviewed.

Results: The average duration between discharge and appointment was 13 days. Out of 258 patients, 119 versus 139 were scheduled before and after 10 days respectively. Overall, 82 (32%) patients were readmitted regardless of their appointment. We analyzed the readmission rate between NS and attendees; 29/68 (43%) NS were readmitted compared with 53/190 (28%) attendees. Out of 190 attendees, 19 (10%) were readmitted on the same day and 34 (18%) were readmitted within 30 days.

Out of all encounters, 38 (15%) patients were scheduled for outpatient paracentesis and 65 (25%) had labs completed before their appointment. Medication adjustments were made in 71/190 (37%) attendees; 14/65 (22%) were based on labs and 39/190 (21%) on symptoms. Medication adjustments were anticipated in 35/190 (18%) pending labs.

Discussion: The 30-day readmission rate was 28% versus 43% for attendees and NS respectively, demonstrating the direct correlation between PHD clinic attendance and reduced readmissions. The 10% of readmissions on the day of their appointment allowed for urgent intervention but demonstrates a flaw in the discharge process. Attendance facilitated scheduling of outpatient paracentesis medications adjustments based on labs and symptoms. Care was delayed for 18% of attendees who did not complete labs prior to their appointment, demonstrating an avenue for improvement.

Our study highlights the importance of PHD visits, safe discharge planning and the importance of labs prior to the appointment. These promote care coordination, timely medication adjustments and resource provision, thus preventing emergent need for hospitalization and morbid outcomes.


Disclosures:


Priya Varghese, MD¹, Kathy Williams, MD¹, Supriya Pradhan, MD¹, Justin Mahr, PA-C¹, Simona Rossi, MD¹, Victor Navarro, MD². A0486 - Relevance of Post-Hospital Discharge Appointments in Patients With Liver Disease, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.