Impact of gastroenterology consultation on the outcomes of patients admitted to the hospital with decompensated cirrhosis

Managed care has strongly discouraged generalists from referring patients t o specialists in an effort to reduce the costs of health care. The aim of t his study was to compare patient outcomes when generalists work together wi th gastroenterologists or alone in the management of patients admitted to t he hospital with decompensated cirrhosis. Consecutive patients admitted to the hospital with decompensated cirrhosis over a 1-year period were identif ied. We compared the length of stay, cost of hospitalization, incidence of hospital readmission, and mortality for patients who did and those who did not have a gastroenterology (GI) consultation. A GI consultation was reques ted for 107 of the 197 patients (54.3%). Patients who had a GI consultation had a significantly shorter length of stay (5.6 +/- 3.5 vs. 10.1 +/- 5.8 d ays, P <.001) and a lower cost of hospitalization ($6,004 +/- $4,994 vs. $1 0,006 +/- $6,183, P <.001) than those patients who were managed by generali sts alone. The 30-day incidence of readmission (13.3% vs. 27.8%, P =.01) an d mortality (7.5% vs. 16.7%, P =.045) were significantly lower in the GI co nsultation group. During a median follow-up of 618 days (range, 2-970), pat ients who had a GI consultation during hospitalization had a significantly longer time to hospital readmission (P <.001) and improved survival (P =.02 ) compared with those who were managed by generalists alone. In conclusion, for patients admitted to the hospital with decompensated cirrhosis, indivi duals who were managed by generalists in conjunction with gastroenterologis ts had better outcomes than those who were managed by generalists alone.