{
  "abstract": "Background Patients with decompensated liver disease face high risk of early readmission and mortality post-discharge. National guidelines from BASL, BSG, and NHS England recommend early identification of palliative needs and structured discharge planning. However, ACP (Advance Care Planning) and referral to supportive care remain inconsistent.Objective To develop and implement an Advanced Chronic Liver Disease (ACLD) MDT to identify patients earlier in the palliative phase and improve outcomes through integrated care pathways, proactive ACP, and enhanced service coordination.Methods A SMART QI goal was developed: Within 12 months, establish an integrated MDT involving hepatologists, Community and hospital palliative care team, liver nurse specialists, Consultant Nurse, Specialist pharmacists, dietitians, alcohol services, and clinical psychologists. Interventions included structured referral protocols, screening tools (e.g., Rockwood Frailty, SPICT, Child-Pugh), community palliative care engagement, and hot clinic follow-up within 14 days. Baseline data on readmission and ACP rates were collected. Outcomes tracked included referral numbers, ACP documentation, 30-day readmissions, and patient/caregiver satisfaction.Results Analysis of 76 patient records revealed:43% (n=33) died within 30 days of discharge, with 28% (n=21) dying within just 14 days.61% of patients who died within 14 days had no recorded ACP or contact with the hot clinic.Among those seen in the hot clinic within 14 days, only 11% died within 30 days, compared to 48% of those who were not seen.Readmission preceded death in 62% of cases, often within 7 days.ACP documentation increased from 18% pre-intervention to 52% post-intervention.MDT meeting attendance rose by 45% as the service matured, with representation across all disciplines.Service Development and future plans:NHS Hospital-at-home services pilot to review patients 48 hours post-discharge for high-risk patients.Community team integration supported real-time care adjustments.A business case for an MDT coordinator role is in development to ensure continuity and sustainability.Impact Improved coordination led to earlier intervention, reduced unplanned admissions, and enhanced satisfaction among patients and caregivers. Staff reported increased confidence in identifying and managing patients in the palliative phase.Conclusion Embedding a structured ACLD MDT with proactive hot clinic follow-up and ACP implementation improves early outcomes, supports national policy, and offers a scalable framework for other regions.References British Association for the Study of the Liver (BASL). (2025) Decompensated Cirrhosis Care Bundle: First 24 Hours. [online] Available at: https://www.bsg.org.uk/clinical-resource/new-decompensated-cirrhosis-admission-care-bundle [Accessed 19 May 2025]. Woodland H, Buchanan RM, Pring A, Dancox M, McCune A, Forbes K, Verne J. Inequity in end-of-life care for patients with chronic liver disease in England. Liver International 2023;43(11):2393–2403. doi:10.1111/liv.15684. British Liver Trust. (2022) Out of Sight – The Hidden Burden of Liver Disease. [online] Available at: https://britishlivertrust.org.uk/[Accessed 19 May 2025]. National Institute for Health and Care Excellence (NICE). (2016) Cirrhosis in over 16s: assessment and management (NG50). [online] Available at: https://www.nice.org.uk/guidance/ng50 [Accessed 19 May 2025]. National Confidential Enquiry into Patient Outcome and Death (NCEPOD). (2013) Measuring the Units: A review of patients who died with alcohol-related liver disease. [online] Available at: https://www.ncepod.org.uk/2013report2/downloads/MeasuringTheUnits_FullReport.pdf [Accessed 19 May 2025]. Hudson B, Hunt V, Waylen A, et al. The invisibility of death: a qualitative study of staff and patient experiences of end-of-life care in liver disease. BMJ Open 2017;7(12):e017241. doi:10.1136/bmjopen-2017–017241. Low JTS, Davis S, Vickerstaff V, et al. Advanced chronic liver disease: a disease with similarities to cancer that needs a holistic approach. BMJ Supportive & Palliative Care 2017;7(2):181–188. doi:10.1136/bmjspcare-2014–000771. National Health Service (NHS) England. (2022) Specialist Liver Services: Service Specification. [online] Available at: https://www.england.nhs.uk/publication/specialised-liver-services/[Accessed 19 May 2025]. Royal College of Nursing (RCN). (2019) Caring for People with Liver Disease: A Competence Framework for Nursing. London: RCN. Shaji S, Neil D, Morling JR, et al. Hospital admissions and outcomes of patients with decompensated liver disease: a nationwide analysis. Liver International 2022;42(8):1763–1773. doi:10.1111/liv.15261. Sharp C, Campbell A, Thompson N. Palliative care in liver disease: an urgent need for better integration. Frontline Gastroenterology 2018;9(2):146–152. doi:10.1136/flgastro-2017–100886.Abstract P103 Figure 1Abstract P103 Table 1 pateint weeks to readmission days to readmoission weeks to death days to death seen in hot clinc? 1 2 14 0.5 14 y 2 8 56 y 3 16 112 y 4 16 112 16 112 n 5 1 35 7 35 n 6 22 154 48 336 y 7 17 119 y 8 23 161 26 182 y 9 y 10 1 4 1 4 n 11 4 28 y 12 6 50 7 46 y 13 7 56 29 203 n 14 18 126 n 15 6 40 n 16 6 40 y 17 6 40 n 18 20 140 n 19 y 20 4 30 6 40 y 21 y 22 n 23 y 24 y 25 y 26 17 112 y 27 y 28 y 29 y 30 12 84 n 31 y 32 12 80 32 224 y 33 y 34 y 35 y 36 26 182 56 395 y 37 y 38 1 8 y 39 1 4 n 40 8 60 y 41 y 42 y 43 9 63 12 83 y 44 n 45 y 46 12 80 24 168 y 47 4 30 6 40 n 48 y 49 4 30 y 50 4 30 y 51 20 140 26 180 y 52 y 53 6 40 7 50 y 54 y 55 n 56 8 60 y 57 6 40 y 58 y 59 y 60 y 61 4 30 n 62 y 63 4 30 y 64 n 65 y 66 Admitted four times since Feb – may y 67 y 68 y 69 7 50 8 60 y 70 5 35 n 71 30 27 190 y",
  "authors": [
    {
      "affiliations": [
        "North Bristol NHS, Bristol, UK"
      ],
      "name": "Katharine Caddick"
    }
  ],
  "title": "P103 Evaluating early outcomes in decompensated liver disease: a QI initiative to integrate palliative care with advanced planning and rapid review",
  "uid": "e3bd86b2-9432-5b31-8110-de981c55a29a"
}