O03 A novel nurse-led early post-discharge clinic is associated with fewer readmissions and lower mortality following an index hospitalisation with decompensated cirrhosis

Background Patients hospitalised with decompensated cirrhosis (jaundice, variceal bleeding, ascites or hepatic encephalopathy) have high rates of early, unplanned readmission, associated increased complications and healthcare costs. Optimising preventative care reduces readmissions but many patients are readmitted before their outpatient review by hepatologists. Consequently, we established a novel pathway nurse-led, structured early post-discharge clinic. seen within 2 weeks discharge, specific interventions for ascites, encephalopathy, varices, alcohol misuse nutrition. The aim our study was to assess impact on readmission mortality. Methods Following an index admission cirrhosis, were in the clinic (intervention cohort) received standard hepatology physician-led follow up (controls). Clinical data including demographics, liver disease aetiology, reason stage analysed. Outcome measures included time first rate mortality 12 months. Results There 91 control 78 intervention cohort. no significant differences age, gender aetiology at mean MELD-Na discharge 18.1 19.8 (p=NS) groups respectively. Ascites most common decompensating event both groups. Median 51 days group 98 (p<0.01). cohort had significantly fewer 30 (12% versus 30%, p<0.01) 90 (27% 49%, not months (58% 68%, p=0.16) overall reduction bed day usage 33%. Mortality 4% deaths group. (5% 15%, p<0.05) (22% 41%, p<0.01). Conclusions hospitalisation goal-directed can be effectively delivered specialist nurses, prior This model readmissions, lower reduced Our suggest such nurse-led models deserve wider implementation further evaluation.