A Process for Improving Utilization in the Management of Cirrhotic Patients with Gastrointestinal Bleeds

1University of Texas Health Science Center at San Antonio, San Antonio, TX

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 202


Given the current health care reform movement, it is clear that hospital utilization will be paramount for hospitals to provide adequate health care while limiting costs.


To examine the utilization data for cirrhotic patients at our institution in hopes of identifying areas to reduce costs without sacrificing patient care.


We reviewed 300 internal medicine patients who were admitted from January 2007 to March 2010 with the MS‐DRG code for cirrhosis and alcoholic hepatitis with major complications/comorbidities to University Hospital, a 604‐bed tertiary‐care center and primary teaching site for our internal medicine program. Cirrhotic patients were charged an average of $31,006 per hospitalization at our institution which was $12,450 above the national average, resulting in a total aggregate cost of $9,301,800. After analyzing the individual charges, multiple areas exceeded national averages. Cirrhotic patients were charged $8400 for an intermediate floor with an average length of stay in that setting of 6 days, with a total aggregate cost of approximately $750,000, which was $230,000 above the system average. Medications including intravenous Protonix and cefotaxime were $77,000 and $10,000 above the average, respectively. Moreover, basic metabolic profile and complete blood count costs were $52,000 and $25,000 above the average, respectively. Finally, costs for complete abdominal sonograms were $6700 above the average (Fig. 1).



Cirrhotic patients are an extremely difficult patient population to manage given the severity of their clinical presentations. Not surprisingly, in our institution, cirrhotic patients accounted for the highest aggregate cost during this 3‐year chart review. After reviewing this data, several areas for potential improved utilization were identified to include downgrading patients to regular beds sooner when medically appropriate, switching patients to oral medications sooner when appropriate, minimizing unnecessary lab draws where appropriate, and using limited, versus complete, sonograms for paracentesis marking. With the use of our electronic medical record, we plan to standardize order sets for these patients that will do all of the following: (1) encourage providers to use a more cost‐effective antibiotic for spontaneous bacterial peritonitis prophylaxis, (2) alert nurses to contact physicians for potential downgrade to a regular bed once certain clinical parameters have been met (Fig. 2), (3) alert nurses to contact physicians after an EGD has been completed to assess whether the patient's intravenous medications can be changed to oral medications, (4) encourage providers to limit repeat complete blood count and basic metabolic profile ordering after admission if not medically necessary, and (5) encourage providers to choose a less expensive imaging study to sonomark patients for paracentesis. We will track the impact of this order set over the next 6 months and beyond in hopes of demonstrating improved utilization in these specific areas.



D. Schmit ‐ UTHSCSA, employment/none; M. Johnson ‐ UTHSCSA, employment/none; L. Leykum ‐ UTHSCSA, employment/none

To cite this abstract:

Schmit D, Johnson M, Leykum L. A Process for Improving Utilization in the Management of Cirrhotic Patients with Gastrointestinal Bleeds. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 202. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/a-process-for-improving-utilization-in-the-management-of-cirrhotic-patients-with-gastrointestinal-bleeds/. Accessed November 22, 2019.

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