Limiting admissions: Innovating care. A ward based ambulatory care model for patients with liver disease

Hospital admissions for complications of cirrhosis continue to rise nationally due to the epidemics of alcohol use disorder and obesity related liver disease. Due to the unstable nature of chronic liver disease up to 30% of patients need to be readmitted within 30 days of discharge. Why is this? Firstly, patients with chronic liver disease develop fluid in the abdomen - ascites. This is uncomfortable and often requires drainage (paracentesis). Secondly these very sick patients can rapidly deteriorate, often before they can be seen in the liver clinic leading to an ED presentation. Can this be avoided? Yes - what if we were able to rapidly review recently discharged patients on the ward within a few days of discharge? What if we could accommodate patients at short notice on the ward for paracentesis when needed rather than patients needing to present to the ED? We developed a ward based ambulatory care facility for liver patients and we think we have made a difference.