P1178 - Evaluating and Improving the Use of Nutritional Interventions in Hospitalized Patients With Cirrhosis: A Quality Improvement Project.

Avneet Singh, DO¹, Alexander Garcia, DO¹, Nicole Debski, BS², Erin Sanzone, BS², Alexis Sieber, BS², Krystal Hunter, PhD, MBA³, Jason Ho, MD⁴, Kathy N. Williams, MD, MS⁵, Christopher Deitch, MD^4
1Cooper University Hospital, Camden, NJ; ²Cooper Medical School of Rowan University, Camden, NJ; ³Cooper University Health Care, Camden, NJ; ⁴Cooper Health Gastroenterology, Camden, NJ; ⁵Cooper University Hospital, Philadelphia, PA

Introduction: Malnutrition is an under-recognized comorbidity in cirrhosis leading to increased mortality. Despite its direct impact on outcomes, the nutritional aspects in cirrhosis care are under-addressed in hospitalized patients. The American Association for the Study of Liver Diseases (AASLD) recommends dietary consultation within 24-hours of admission and initiation of a low sodium diet for patients with cirrhosis. Our project aims to assess nutritional interventions in hospitalized cirrhosis patients through retrospective collected data.

Methods: The project was split into three phases: 1) retrospective chart review assessing utilization of nutritional intervention, 2) development of a cirrhosis order-set and educational lectures and 3) post-intervention analysis. The Epic self-service reporting tool, SlicerDicer, was used to identify hospitalized cirrhosis patients between January 2023 and January 2024. Patients were then sub-categorized into three groups; hepatic encephalopathy (HE), ascites, or gastrointestinal bleed (GIB). Data extraction pertaining to demographics, BMI, sodium restriction, and RD consultation were abstracted.

Results: 197 patients were identified with a mean age of 56.32 ± 12.49 and mean length of stay of 8.93 ± 7.34. The mean BMI was 27.71 ± 7.51 and 70/197 (35.5%) of patients had a normal BMI (18.5-24.9), while 57.9% were overweight/obese and 6.6% underweight. Male (72.1%) patients exceeded females (27.9%). Majority of patients were Black (44.2%) and the leading cause of cirrhosis was alcohol use (62.9%). The most common admission diagnosis was ascites (50.8%) followed by GIB (25.9%) and HE (23.4%). At admission 66/197 (33.5%) of the patients were started on a low sodium diet, while 52/197 (26.45%) had a RD consult placed within 24 hours. Stratified by diagnosis, a low sodium diet was initiated most frequently for ascites (40%) and a RD consult was placed most often for GIB (39.2%). The average hospital length of stay for patients was significantly shorter in patients who had an RD consult compared to those who did not (6 days vs 8 days p= .04).

Discussion: Our QI project revealed there was an underutilization of a low sodium diet and RD consultation. Phase 3 will examine if there is an increase in initiation of a low sodium diet and RD consultations with the implementation of a cirrhosis order-set. In addition, with the help of RDs, education will be given to providers and physicians regarding the impact of nutrition in hospitalized cirrhosis patients.


Disclosures:


Avneet Singh, DO¹, Alexander Garcia, DO¹, Nicole Debski, BS², Erin Sanzone, BS², Alexis Sieber, BS², Krystal Hunter, PhD, MBA³, Jason Ho, MD⁴, Kathy N. Williams, MD, MS⁵, Christopher Deitch, MD⁴. P1178 - Evaluating and Improving the Use of Nutritional Interventions in Hospitalized Patients With Cirrhosis: A Quality Improvement Project., ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.