Management of patients with cirrhosis in the emergency department: Implications for hospitalization outcomes

Abstract

Sepsis in patients with cirrhosis is associated with particularly poor outcomes, [4] and several tools are available for the rapid identification of high-risk patients with sepsis in the ED. The recent Sepsis-3 criteria and the quick Sequential Organ Failure Assessment tool have been validated in patients with cirrhosis and are more accurate than the SIRS criteria in this population. [6][7][8] Additionally, the Chronic Liver Failure-Sequential Organ Failure Assessment model has demonstrated superior predictive performance for patients with cirrhosis presenting with infection compared to the Sepsis-3 criteria and Sequential Organ Failure Assessment [8][9][10] and could serve as a valuable tool for EM providers. Prompt critical care evaluation is crucial for patients identified as high-risk, particularly for

Hospitalized patients with cirrhosis: Addressing gaps in care

“…To overcome the knowledge gap due to time restrains and difficulty for hospital practitioners to keep up to date with the latest guidelines, many QI trials have used easy-to-access and time-efficient tools to reduce variation in clinical practice: handheld checklists, 16 templated notes, 17 best practice alerts/decision support, 16 and clinical pathways/order sets 18,19 . More resource-intensive solutions have addressed institutional logistics and culture changes but require high commitment across all shareholders: “best practice” in emergency room focusing on timely interventions, 20 dedicated teams to perform emergency room or inpatient paracentesis, 21 bundled interventions to ensure timely performance of diagnostic paracentesis (education + workflow support/ultrasound/premade kits + alert + orderset) 22 or postdischarge care management programs 23,24 …”