{
  "abstract": "Acute decompensated cirrhosis (DC) and acute-on-chronic liver failure are common reasons for hospital admission that have a high in-hospital mortality rate (10%–20%). Patients require a detailed assessment for precipitating factors and management of complications such as infections, ascites, acute kidney injury and hepatic encephalopathy. Multiple reports have demonstrated unwarranted variability in the care of patients with DC. In 2014, the British Society of Gastroenterology (BSG)/British Association for the Study of the Liver (BASL) DC care bundle (DCCB) was introduced to provide a structured approach for the management of patients with DC in the first 24 hours. Usage of the DCCB has been shown to improve care of patients with DC. However, despite evidence indicating the beneficial impact of the DCCB, overall usage across the UK was only 11.4% in a national audit. Our aim was to update the DCCB to incorporate recent advances in care and improve its usability and develop a strategy to improve its usage nationally. The updated bundle was developed by a multidisciplinary group of specialists from BSG, BASL and the Society for Acute Medicine with the quality of evidence supporting the bundle recommendations assessed using the Grading of Recommendation Assessment Development and Evaluation tool. Proposed minimum standards for audit were also developed. Finally, a strategy to promote usage of the bundle including education/training at a national and local level, improving accessibility for the bundle, and promotion of frameworks for use at an institutional level to improve and monitor utilisation of DCCB.",
  "authors": [
    {
      "affiliations": [
        "Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK",
        "Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK"
      ],
      "name": "Stuart McPherson"
    },
    {
      "affiliations": [
        "Liver Unit, Queen Elizabeth Hospital, Birmingham, UK"
      ],
      "name": "Nadir Abbas"
    },
    {
      "affiliations": [
        "Cambridge University Hospital NHS Foundation Trust, Cambridge, UK"
      ],
      "name": "Michael E D Allison"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Hepatology & Endoscopy, Hull Royal Infirmary, Hull, UK"
      ],
      "name": "Dianne Backhouse"
    },
    {
      "affiliations": [
        "St George’s Healthcare NHS Trust, London, UK"
      ],
      "name": "Helen Boothman"
    },
    {
      "affiliations": [
        "Acute Medicine, The Christie NHS Foundation Trust, Manchester, UK"
      ],
      "name": "Tim Cooksley"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Hepatology & Endoscopy, Hull Royal Infirmary, Hull, UK"
      ],
      "name": "Lynsey Corless"
    },
    {
      "affiliations": [
        "Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK"
      ],
      "name": "Thomas Crame"
    },
    {
      "affiliations": [
        "Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"
      ],
      "name": "Timothy J S Cross"
    },
    {
      "affiliations": [
        "Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"
      ],
      "name": "Joanna Henry"
    },
    {
      "affiliations": [
        "Royal Free Hospital, London, UK"
      ],
      "name": "Brian Hogan"
    },
    {
      "affiliations": [
        "Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK",
        "Gateshead Health NHS Foundation Trust, Gateshead, UK"
      ],
      "name": "Dina Mansour"
    },
    {
      "affiliations": [
        "Gastroenterology, NHS North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "Giovanna McGinty"
    },
    {
      "affiliations": [
        "Royal Alexandra Hospital, Paisley, UK"
      ],
      "name": "Gordon McKinnon"
    },
    {
      "affiliations": [
        "Gastroenterology, Bedford Hospital, Bedford, UK"
      ],
      "name": "Jay Patel"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, UK"
      ],
      "name": "Oliver D Tavabie"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Felicity Williams"
    },
    {
      "affiliations": [
        "Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK"
      ],
      "name": "Coral Hollywood"
    }
  ],
  "title": "Decompensated cirrhosis: an update of the BSG/BASL admission care bundle",
  "uid": "0eea30be-6bb7-5ea4-a327-9d57d3f3d67a"
}