title: A prospective study of a protocol that reduces readmission after liver transplantation.
abstract: Health care has shifted to placing priority on quality and value instead of volume. Liver transplantation uses substantial resources and is associated with high readmission rates. Our goal was to determine if a protocol designed to reduce readmission after liver transplant was effective. We conducted a prospective study of a protocol designed to reduce readmission rates after liver transplantation by expanding outpatient services and alternatives to readmission. The 30-day readmission rate 1 year after implementing the protocol was compared to the 30-day rate for 2 years prior to implementation. Multivariate analysis was used to control for potential confounding factors. Over the study period, 167 adult primary liver transplants were performed with a mean biological Model for End-Stage Liver Disease score of 21 ± 8. Fifty-seven (34%) patients were readmitted. The most common reason for readmission was biliary complications (n = 13). The 30-day readmission rate decreased from 40% before implementing the protocol to 20% after implementation (P = 0.02). In multivariate analysis, the protocol remained associated with readmission (odds ratio, 0.39; 95% confidence interval, 0.16-0.92; P = 0.03). The mean length of stay after transplant was 13 ± 12 days preprotocol and 9 ± 5 days postprotocol (P = 0.09). Alternatives to readmission, including hospital lodging and observation status, were main factors in reducing readmission rates. If the most recent definitions of inpatient admission and observation status were applied over the entire study period, then the readmission rates preprotocol and postprotocol were 31% and 20% indicating that the revised definition of observation status accounted for 45% of the reduction in the readmission rate. Readmission after liver transplantation can be reduced without increasing length of stay by implementing a specifically designed protocol that expands outpatient services and alternatives to inpatient admission. Liver Transplantation 22 765-772 2016 AASLD.
authors.affiliation: Division of Hepatology and Transplant Surgery, Carolinas Healthcare System, Charlotte, NC.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Russo
authors.affiliation: Division of Hepatology and Transplant Surgery, Carolinas Healthcare System, Charlotte, NC.
authors.forename: David M
authors.initials: DM
authors.lastname: Levi
authors.affiliation: Division of Hepatology and Transplant Surgery, Carolinas Healthcare System, Charlotte, NC.
authors.forename: Ruth
authors.initials: R
authors.lastname: Pierce
authors.affiliation: Division of Hepatology and Transplant Surgery, Carolinas Healthcare System, Charlotte, NC.
authors.forename: Vincent
authors.initials: V
authors.lastname: Casingal
authors.affiliation: Division of Hepatology and Transplant Surgery, Carolinas Healthcare System, Charlotte, NC.
authors.forename: Lon
authors.initials: L
authors.lastname: Eskind
authors.affiliation: Division of Hepatology and Transplant Surgery, Carolinas Healthcare System, Charlotte, NC.
authors.forename: Andrew
authors.initials: A
authors.lastname: deLemos
authors.affiliation: Division of Hepatology and Transplant Surgery, Carolinas Healthcare System, Charlotte, NC.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Schmeltzer
authors.affiliation: Division of Hepatology and Transplant Surgery, Carolinas Healthcare System, Charlotte, NC.
authors.forename: Philippe J
authors.initials: PJ
authors.lastname: Zamor
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods* / Q000706:statistics & numerical data; D002985:Clinical Protocols; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects* / Q000191:economics; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult