Patients who are admitted to the hospital with cirrhosis have significant morbidity and mortality when they present with complications of end-stage liver disease. Complications such as hepatic encephalopathy and gastrointestinal bleeding lead to increased length of stay, readmission, intensive care utilization and inpatient mortality.
Led by Jamil S. Alsahhar, MD, medical director of inpatient hepatology at Baylor University Medical Center at Dallas, part of Baylor Scott & White Health (BSWH), the BSWH hepatology team is helping lead a new systemwide initiative to improve liver care in patients with cirrhosis across all of the hospitals in Baylor Scott & White Health. These best care pathways and quality measures are based on the explicit process-based and outcome-based measures for adults with cirrhosis developed by the Practice Metrics Committee of the American Association for the Study of Liver Diseases. The hepatology team is working with the BSW Unsupported Clinical Variation Core Team Meeting to develop these standards.
Dr. Alsahhar is leading the effort to design interventions for early antibiotic administration for gastrointestinal bleeding in patients with cirrhosis. In addition, he is helping to lead interventions to reduce readmissions for hepatic encephalopathy. This includes collaborating with Pharmacy and Care Coordination teams to provide appropriate medications at discharge to prevent readmissions.
“It truly is exciting to be able to leverage the integrated health care system resources and EMR technologies to identify patients at high risk for complications and intervene at an early stage to improve the quality of care we provide,” Dr. Alsahhar says.
Baylor Scott & White is also a pilot site for the Cirrhosis Quality Collaborative, a consortium of centers looking to improve liver disease care across the United States. Both of these initiatives serve to improve cirrhosis care at the regional and national level.
Innovative approaches increase access to liver transplant for patients with low MELD scores
Historically, in any transplant program worldwide, patients had to be extremely sick and have a high Model for End-stage Liver Disease (MELD) score to receive a liver transplant. However, often the MELD score does not represent how sick the patient truly is.
Remarkable discovery of regeneration of islet cells from leftover tissue
Baylor University Medical Center, part of Baylor Scott & White Health, operates the only transplant program in Texas offering total pancreatectomy followed by islet auto-transplantation (TPIAT) for acute relapsing and chronic pancreatitis. A TPIAT is performed to alleviate the pain of chronic pancreatitis and retain the endocrine function.
Treatment advances made in bronchiectasis
There is hope on the horizon for patients with bronchiectasis with recent advances in treatment options.
Sleep apnea increases risk of death in patients with heart failure
Sleep disordered breathing (SDB) and heart failure (HF) are inextricably linked. Obstructive sleep apnea (OSA) is highly prevalent and is associated with adverse outcomes in patients with HF.