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• W4381112951 abstract "<h3>Introduction</h3> Decompensated cirrhosis is a major complication of liver disease and represents a significant burden on health services. The BSG and BASL developed a care bundle to be completed at the time of discharge and includes a checklist designed to optimise management of cirrhotic patients on discharge. This study aims to observe the impact on documentation and patient care following implementation of the bundle. <h3>Methods</h3> This study took place in a large district general NHS hospital. Data was collected from patients with clinical coding of ‘Decompensated Liver Cirrhosis’ from October 2020 to March 2021 and compared with patients from October 2021 to March 2022 after introduction of the bundle. A third, smaller cycle of data collection was completed between March and July 2023 and is reported separately. Data was collected from electronic notes. <h3>Results</h3> A total of 30 patients from Pre-bundle group and 33 from the post-bundle group were compared. Males were the dominant gender (70%) and mean UKELD score was 57 in both groups, with a mean age of 55 in the pre-bundle and 57 in the post-bundle group, respectively. Alcohol was the commonest aetiology of cirrhosis and precipitating factor for decompensation in both cohorts. Significant improvement was seen in documentation on discharge summaries, including the date of first outpatient appointment (OPA), (57% vs 84%), renal function (5% vs 92%), a plan for renal function monitoring (10% vs 88%) and diuretic titration (26% vs 77%). Renal function was checked more rigorously within 4 weeks of discharge following implementation of the bundle (68% vs 98%), and management of varices improved, including advice for titration of beta-blockers from 0–50%. Readmission rates pre- and post-bundle were 47% and 36%, and mortality rates were 27% vs 4%; both were documented at 3 months following discharge. A third data collection was completed to assess for trends in clinical practice. OPA was offered in 4 weeks to 94%, and 94% of patients had their renal function checked within 4 weeks of discharge. All eligible patients requiring OGD for primary or secondary prophylaxis had it booked and documented at discharge. Advice to titrate beta blockers was documented in 87% of eligible patients. Patient education, a cirrhosis information booklet given to patients at discharge (or documentation thereof), was consistently poor, at 0%, 33% and 16% respectively. Likewise, a ceiling of care was documented in only 10%, 12% and 16% patients in the three groups. <h3>Conclusion</h3> Implementation of the BASL BSG Discharge Care Bundle for patients with decompensated cirrhosis improves quality of documentation on discharge, follow up arrangements, and has the potential to improve patient outcomes. Aspects of care primarily pertaining to patient education, communication, and long-term planning, remain poor." @default.
• W4381112951 created "2023-06-19" @default.
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• W4381112951 date "2023-06-01" @default.
• W4381112951 modified "2023-09-27" @default.
• W4381112951 title "P14 QIP on decompensated cirrhosis discharge care bundle" @default.
• W4381112951 doi "https://doi.org/10.1136/gutjnl-2023-bsg.88" @default.
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