Standardization of the Cirrhosis Admission Process and Its Impact on Inpatient Management and Patient Outcomes

An increase in cirrhosis-related hospitalizations has highlighted opportunities for improved patient care and standardization of practice. We created a cirrhosis admission order set with the goal of promoting guideline-directed care and improving patient outcomes.

We developed and implemented a cirrhosis order set that included dietary recommendations, diagnostic paracentesis orders and studies, common complications of portal hypertension and educational materials at time of discharge. We used a retrospective cohort design to compare post-intervention process measures and outcomes.

The use of the order set resulted in a significant increase in low sodium diet (93% vs. 37%, p = 0.001), high protein diet (91% vs. 37%, p = 0.001) and diagnostic paracentesis (46% vs. 26%, p = 0.001) performed during admission. There was also a significant reduction in time to diagnostic paracentesis (460 min vs. 1210 min, p = 0.03) and less all-cause Emergency Department visits (32% vs. 46%, p = 0.006) in the order set group. There was no significant impact on length of stay, readmission rates or in-hospital mortality.

The use of a standardized order set improves inpatient management of cirrhosis and encourages guideline-directed care. This order set could easily be replicated at other institutions or among non-cirrhotic patient populations. Future work should focus on further standardization of the discharge process with the goal of having a more tangible impact on length of stay and readmission rates.