COLLABORATION BETWEEN ACUTE MEDICAL AND HEPATOLOGY TEAM SIGNIFICANTLY IMPROVES OUTCOMES OF PATIENTS WITH DECOMPENSATED CIRRHOSIS

IntroductionA quality improvement project was carried out at a district general hospital focusing on the clinical management of patients presenting with decompensated liver cirrhosis.MethodA project group was formed comprising of three hepatologists, an advanced nurse practitioner (ANP) in hepatology, two acute medical consultants and a nurse acting as liver champions on the medical admissions unit (MAU) and a member from care quality improvement team. Quality Improvement principles, like driver diagram, were employed to narrow down focused interventions which would improve outcomes. Four key interventions were made; a) Educational sessions delivered by the hepatology team to consultants, junior doctors, physician associates and nurses on MAU b) Training of carrying out ascitic taps and drains, delivered by the Hepatology ANP to acute medical team, doctors in training and allied health professions c) Implementation of the BSG-BASL cirrhosis care bundle d) Provision of Specialist review within 24 hour of patients admitted on MAU. A 18-month worth of electronic documentary review and analysis of patients’ health records pre- and post- intervention was carried out.ResultsThe interventions were started in July 2020 and Statistical Process Control charts were utilised to analyse and evaluate statistical significance which shows an improvement in key indicators.ConclusionWe have demonstrated that engagement of the appropriate teams with targeted training and support at an intensive level can significantly improve the delivery of care for decompensated cirrhosis patients by non-specialist/emergency care teams. This has the potential to dramatically improve the outcome of these patients.