In Hepatology Communications, Shazia Mehmood Siddique and colleagues investigate nonmedical factors that influence inpatient admission for patients with cirrhosis who present to the emergency department. They also explore provider perspectives on patients presenting to the emergency department with low-acuity conditions, such as ascites and hepatic encephalopathy. The authors survey emergency medicine and hepatology providers, including attending physicians, house staff, and advanced practitioners, in four liver transplant centers.
From the 186 responses analyzed, they identified several nonmedical factors tht affect inpatient triage decisions. The factors include including input from a hepatologist, patient access to outpatient specialty care, and patient need for diagnostic testing for a procedure. When given patient-based scenarios of low-acuity cases, most providers did not believe hospitalizing the patient was the appropriate action, but indicated that the patient would be hospitalized at their institution. Several perceived barriers, including limited resources in the outpatient setting and emergency department, were cited for this discrepancy. Finally, most providers believed that an emergency department observation unit protocol would influence whether or not patients are admitted. The authors conclude that these findings could inform quality improvement initiatives and provide a basis for protocols to prevent inpatient admission for low-acuity cases.