{
  "abstract": "Introduction Decompensated cirrhosis (DC) is associated with frequent hospital admissions and prolonged inpatient stays, contributing to significant healthcare resource utilisation. The British Society of Gastroenterology (BSG) has emphasised the importance of structured outpatient care pathways, including multidisciplinary team (MDT) approaches, to improve patient outcomes and reduce hospital dependency in this population. This study evaluates the practicality and impact of a dedicated MDT clinic on healthcare utilisation among patients with decompensated cirrhosis.Methods A dedicated MDT clinic was established at a district general hospital (DGH), comprising a consultant hepatologist, advanced nurse practitioner (ANP), dietician, physiotherapist, palliative care specialist, and assertive alcohol outreach worker. All patients were discussed in an MDT immediately prior to clinic and were then reviewed by the appropriate members of the team. Patients were referred to the clinic for comprehensive outpatient management following an admission with decompensated cirrhosis, or if they had decompensated as an outpatient, aligning with BSG recommendations. A retrospective analysis of 79 patients who had attended clinic compared total bed days, number of admissions (excluding day case admissions), and mean length of hospital stay during the 90 days before and after the initial clinic attendance.Results In the 90 days preceding clinic attendance, 79 patients accounted for 743 hospital bed days, which decreased to 220 bed days in the 90 days following clinic attendance—a reduction of 523 bed days (70.4%). The number of admissions longer than one day decreased from 71 to 37 (47.9% reduction). The mean length of hospital stay per admission reduced from 10.5 days to 6 days (43.1% reduction). Elective day case activities, such as paracentesis, continued to be supported through outpatient services.Abstract P96 Table 1Local data demonstrating the pre and post clinic intervention metrics, including actual number and percentage changes for a number of key KPIs Metric 90 Day Admissions Pre Clinic 90 Days Admissions Post Clinic Reduction % Reduction Total Admissions 71 37 34 47.9% Bed Days (Total) 743 220 523 70.4% Total Estimated Cost (£)* £593,942.80 £175,912.00 £418,030.80 Average LOS (days) 10.46 5.95 4.51 43.1% Cost Per Admission (£) £8362.62 £4755.62 £3607.00 * All cost estimates are based on a business-accounting verified cost of £799.60 per bed day, calculated from a sample of 10 randomly selected patients with decompensated cirrhosis.**The Mean average of the 10 patients was 15.1, and median 7. These values are relating to individual admissions from the pre clinic period.***n=79 individual patients, data taken from the first attendance to the decompensated MDT clinicDiscussion The implementation of a multidisciplinary clinic for patients with decompensated cirrhosis, in line with BSG outpatient care guidelines, resulted in significant reductions in hospital bed days, admission frequency, and length of stay. The integration of hepatology, nursing, allied health, palliative care, and addiction services facilitated proactive management of complications and reduced hospital dependency. These findings support the efficacy of structured MDT outpatient models in improving care quality and reducing healthcare burden in advanced liver disease and demonstrate its practicality in a DGH setting.References Williams R, Aspinall R, Bellis MA, Camps-Walsh G, Cramp ME, Dhawan A, Ferguson J, Forton D, Foster GR, Gilmore I, Hudson M, Kelly D, Langford A, McDougall N, McPherson S, O’Grady J, Pryke R, Rutter H, Ryder S, Sheron N, Storey K, Verne J, Wright T, Newsome PN. Outpatient care of people with alcohol-related liver disease and decompensated cirrhosis: a multidisciplinary ‘day-case’ model from the British association for the study of the liver (BASL) decompensated cirrhosis working group. Frontline Gastroenterology 2023;14(6):462–470. [online] Available at: https://fg.bmj.com/content/14/6/462 [Accessed 13 May 2025].British Society of Gastroenterology and British Association for the Study of the Liver, 2020. Cirrhosis discharge bundle – long version v1.1. [online] Available at: https://www.bsg.org.uk/getattachment/eeecefff-8776–4da8–9257-fc1cd330f4c5/Cirrhosis-discharge-bundle-long-V1–1-BSG-BASL-25–08-2020.pdf?lang=en-US [Accessed 13 May 2025].Cox L, Ballesteros K, Sharma V. Impact of a joint clinical specialist nurse and dietitian clinic on health-related quality of life outcome in patients with decompensated liver disease. Gut 2024;73(Suppl 3):A3. [online] Available at: https://doi.org/10.1136/gutjnl-2024-BASL.3 [Accessed 13 May 2025]",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Dorset, Poole, UK"
      ],
      "name": "Andrew Wellstead"
    },
    {
      "affiliations": [
        "University Hospitals Dorset, Poole, UK"
      ],
      "name": "Christopher John"
    },
    {
      "affiliations": [
        "University Hospitals Dorset, Poole, UK"
      ],
      "name": "Annabel Wyeth"
    },
    {
      "affiliations": [
        "University Hospitals Dorset, Poole, UK"
      ],
      "name": "Suzie Jupp"
    }
  ],
  "title": "P96 A multidisciplinary decompensated discharge clinic is both possible and effective in reducing total number of bed days and length of stay",
  "uid": "4e394d62-cae5-5bb4-8a78-cf40ec3ff84d"
}