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Title: | A novel, nurse-led 'one stop' clinic for patients with liver cirrhosis results in fewer liver-related unplanned readmissions and improved survival |
Authors: | Kalo, Eric;Baig, Asma;Gregg, Emily;George, Jacob;Read, Scott A.;Ma, Wai-See;Ahlenstiel, Golo |
WSLHD Author: | Kalo, Eric;Baig, Asma;Gregg, Emily;George, Jacob;Read, Scott A.;Ma, Wai-See;Ahlenstiel, Golo |
Subjects: | Nursing;Hepatology |
Issue Date: | 2023 |
Citation: | BMC gastroenterology 23(1):356, 2023 |
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. |
URI: | https://wslhd.intersearch.com.au/wslhdjspui/handle/1/8361 |
DOI: | https://dx.doi.org/10.1186/s12876-023-02986-y |
Journal: | BMC gastroenterology |
Type: | Journal Article |
Study or Trial: | Cohort Analysis Comparative Study Controlled Study Pilot Study |
Department: | Gastroenterology and Hepatology Ambulatory Care |
Facility: | Blacktown Westmead Auburn |
Affiliated Organisations: | Blacktown Clinical School and Research Centre, School of Medicine, Western Sydney University, Blacktown, NSW 2148, Australia Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, Australia Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia |
Keywords: | Liver cirrhosis Patient discharge Nurse's role |
Appears in Collections: | Blacktown Mount Druitt Hospital |
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