Impact of GI consultation on patients admitted to hospital with decompensated cirrhosis

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Hepatology 2001; 34: 1089-95

10 December 2001

Impact of GI consultation on patients admitted to

hospital with decompensated cirrhosis

For patients admitted to hospital with decompensated

cirrhosis, individuals managed by generalists in

conjunction with gastroenterologists have better

outcomes than those managed by generalists alone,

finds a study reported in December's Hepatology.

A team from New York, USA, investigated the impact of

gastroenterology consultation on the outcomes of

patients admitted to hospital with decompensated

cirrhosis.

Managed care has strongly discouraged generalists from

referring patients to specialists in an effort to

reduce the costs of health care.

The researchers looked at when generalists work

together with gastroenterologists and when they work

alone.

A total of 197 consecutive patients, admitted to the

authors' hospital with decompensated cirrhosis over a

1-year period, were identified.

Length of stay, cost of hospitalization, incidence of

hospital readmission, and mortality for patients who

did, and those who did not, have a gastroenterology

(GI) consultation were compared.

A GI consultation was requested for 107 (54%) of the

patients.

Patients who had a GI consultation had a significantly

shorter length of stay (5.6 vs 10.1 days) and a lower

cost of hospitalization ($6004 vs $10,006) than those

patients who were managed by generalists alone.

The researchers found that 30-day incidence of

readmission (13% vs 28%) and mortality (8% vs 17%)

were significantly lower in the GI consultation group.

During a median follow-up of 618 days, patients who

had a GI consultation during hospitalization had a

significantly longer time to hospital readmission and

improved survival compared with those who were managed

by generalists alone.

Author Edmund J. Bini, of the VA New York Harbor

Healthcare System and NYU School of Medicine, said on

behalf of his group, " For patients admitted to the

hospital with decompensated cirrhosis, individuals who

were managed by generalists in conjunction with

gastroenterologists had better outcomes than those who

were managed by generalists alone " .

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