O2 Implementing a nurse-led early discharge clinic for patients with decompensated chronic liver disease to reduce readmission rates and length of hospital stay

Following a patient’s initial presentation with decompensated liver disease, the condition often progresses rapidly, ultimately resulting in death or liver transplantation (Taper, et al.,2016). In-hospital mortality for this population ranges from 10–20% (Volk et al.,2012), and frequent unplanned readmissions pose significant burden on patients and healthcare services. Most readmissions can be avoided with effective secondary preventative measures; however, patients are frequently readmitted prior to outpatients’ follow-up (Giles, et al.,2023). This project aims to implement a nurse-led Early Discharge Clinic (EDC) for patients with decompensated cirrhosis, intending to optimise patients‘ follow-up, subsequently reducing the waiting list for outpatient clinics, reducing the delay in implementing early interventions, reducing readmission rates and, where possible, the length of hospital stays. This clinic intends also to improve overall patient and families’ experiences, and ultimately reduce costs for the NHS. A first retrospective data analysis was conducted, looking at patients with decompensated cirrhosis admitted to hospital from September to December 2023 (cohort1). Patients’ length of admission, date of first appointment offered, date of first appointment and rate of readmissions between discharge and first outpatient appointment was evaluated. A further quantitative data analysis was conducted after implementing the EDC from February to August 2024 (cohort2). A patient and family feedback form was completed to include qualitative data. Following the implementation of the EDC, patients in cohort 2 experienced significantly shorter hospital stays (8days vs. 15days in cohort 1) and substantially reduced waiting times for outpatient follow-up, with cohort 1 facing delays nearly three times longer. Patients in cohort 2 demonstrated a lower readmission rate. While direct measurement of morbidity and mortality was not feasible in this project, existing evidence supports the association between early intervention and improved clinical outcomes in decompensated liver disease. Notably, 90% of patients and families (cohort2) rated the care received as ‘very good’ or’excellent.’ The implementation of a nurse-led EDC has demonstrated clear value in improving the care of patients with decompensated cirrhosis. While the findings are encouraging, it is important to acknowledge the small sample size. This project remains ongoing and continues to evolve, with the establishment of a direct partnership with dietitians and physiotherapists aiming to further enhance the quality and scope of holistic care provided. Additionally, a notable outcome of the project has been the increased job satisfaction reported by the Specialist Nurses leading the clinic, reinforcing the positive impact of such projects on staff engagement and professional fulfilment. 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