SHM Converge Scientific Abstract ePoster Gallery-Understanding Management of Alcoholic Hepatitis at a Large Tertiary Care and Liver Transplant Center

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This quality improvement project examined how alcoholic hepatitis (AAH) is diagnosed and managed at a large tertiary care and liver transplant center. AAH is a serious complication of heavy alcohol use, associated with high mortality and progression to chronic liver disease. Current guidelines recommend using Maddrey’s discriminant function (MDF) to determine severity and guide prednisolone treatment when MDF is 32 or higher, but diagnosis in the hospital is often inconsistent.<br /><br />The team queried the electronic health record for patients admitted between January and June 2021 with AAH-related ICD-10 codes and documented AAH-related active problems. Relevant documentation, labs, and management decisions were abstracted.<br /><br />A total of 115 patients were identified. Only about half had documentation supporting formal AAH criteria or an MDF calculation. Overall, 27 patients met criteria for severe AAH, and 25 received prednisolone, though 8 cases involved inappropriate steroid use. Jaundice was documented in 52 patients, and discharge problem lists included AAH in 64 cases. Diagnostic accuracy was imperfect, with many patients not consistently meeting or documenting key laboratory criteria.<br /><br />Management appeared to differ based on whether patients were experiencing alcohol withdrawal: those without withdrawal had higher bilirubin, longer PT, more frequent PT ordering, and a higher rate of meeting criteria for severe AAH than those with withdrawal, suggesting possible bias or inconsistent clinical assessment.<br /><br />The authors concluded that there is substantial institutional variation in AAH diagnosis and treatment, creating missed opportunities for guideline-concordant care. Future steps include assessing hepatology consultation patterns and creating an admission checklist or smart phrase to standardize AAH documentation and management.

Asset Subtitle

Katherine M. Cooper

Meta Tag

Author List Alessandro Colletta, Deepika Devuni, Katherine M. Cooper

Category Research

Concept Acute Alcoholic Hepatitis

Concept Medically Ready for Discharge Date

Concept Guideline-Based Management

Concept Quality Improvement

Concept Severity Criteria

Distinguished Non-Finalist

Presenter Organization University of Massachusetts Medical School

Presenting Author Katherine M. Cooper

Track Quality Improvement

Keywords

alcoholic hepatitis

quality improvement

Maddrey discriminant function

prednisolone

liver transplant center

diagnostic accuracy

guideline adherence

electronic health record

alcohol withdrawal

standardized documentation

Acute Alcoholic Hepatitis

Medically Ready for Discharge Date

Guideline-Based Management

Quality Improvement

Severity Criteria