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San Francisco—Patients frequently require readmission within 30 days of discharge following liver transplantation, but the rate can be substantially reduced through consistent implementation of a multi-step program that emphasizes education and offers alternatives to readmission.

MW Russo and colleagues presented these findings in poster 17 at the 2015 annual meeting of the AASLD held here recently. Click here to access the entire abstract.

The group at the Carolinas Medical Center and Carolinas Healthcare System in Charlotte, NC, implemented a strategy in October 2013 to reduce early readmissions following liver transplantation. The protocol revised the criteria for readmission, provided alternatives, emphasized patient education, formalized discharge planning, and expanded outpatient services for patients who had undergone liver transplantation.

The team analyzed readmission rates for 167 liver transplantation patients from January 1, 2012 through December 31, 2014. In 2012, the year prior to implementation of the protocol, the 30-day readmissions rate for transplantation patients was 40%. A year after implementation, it had dropped to 19%.

Age, MELD score, indication, dialysis pre- or post-liver transplant, distance to transplant center, length of stay, weekend discharge, insurance, and transfusion were not significant factors in predicting readmission. Expanding outpatient services and offering alternatives to readmission were the top factors in reducing the readmission rate.

Patients had a mean biologic MELD score of 21 and mean age of 54; 63% were male. Hepatitis C infection was the most common indication (35%), followed by non-alcoholic fatty liver disease (18%), hepatocellular carcinoma (17%) and ETOH (13%). Patients stayed in the ICU for an average of 3.4 days and in the hospital for an average of 12.6 days.