title: Optimising the care of patients with cirrhosis and gastrointestinal haemorrhage: a quality improvement study.
abstract: BACKGROUND
  Patients with cirrhosis and gastrointestinal haemorrhage are a complex group with high thirty-day mortality rates.
  
  
  OBJECTIVE
  To evaluate the quality of care delivered to patients admitted with gastrointestinal (GI) haemorrhage to a tertiary care centre before and after implementing a quality improvement initiative for better adherence to practice standards.
  
  
  METHODS
  This is a prospective cohort study. All patients admitted to a tertiary care centre with a GI haemorrhage and known or suspected chronic liver disease were evaluated before and after the quality improvement initiative was implemented. Interventions to improve quality of care included the delivery of educational sessions for medical practitioners, and creation and implementation of standardised admission order sets. Quality of care measures included delivery of prophylactic antibiotics (PAs) within 24 h of admission, delivery of a somatostatin analogue (SA) and use of a proton pump inhibitor (PPI); optimal care was defined as receiving all three. Secondary outcomes included hospital length of stay (LOS) and 30-day readmission rate.
  
  
  RESULTS
  In comparing the preintervention and postintervention groups, we found significant gains in delivering PAs (57% vs. 75%, P=0.05), SAs (54% vs. 76%, P=0.013) and overall optimal care (41% vs. 65%, P=0.008). Use of PPIs did not change and remained in accordance with guidelines (90% vs. 87%, P=0.67). Hospital LOS remained similar between the two groups (6.8 vs. 7.1, P=0.88), whereas the 30-day readmission decreased (41% vs. 13%, P=0.001).
  
  
  CONCLUSIONS
  Implementation of quality improvement initiatives, such as targeted educational efforts and standardised order sets, can improve the quality of care delivered and patient outcomes in patients with cirrhosis and GI haemorrhage.
authors.affiliation: Section of Gastroenterology and Hepatology, University of Wisconsin, School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Johnson
authors.forename: B J
authors.initials: BJ
authors.lastname: Spier
authors.forename: J A
authors.initials: JA
authors.lastname: Leff
authors.forename: M R
authors.initials: MR
authors.lastname: Lucey
authors.forename: A
authors.initials: A
authors.lastname: Said
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006761:Hospitals / Q000592:standards; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards*; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards*