{
  "abstract": "Introduction Identification of patients with advanced liver fibrosis in primary care requires streamlined pathways to ensure timely specialist hepatology reviews. When we miss or delay referrals for high-risk patients (Fibroscan >11.5 kPa), the consequences are severe. It leads to missed windows for essential HCC and oesophageal varices screening and ultimately results in preventable hospital admissions for decompensated liver disease. This project looked to evaluate the current GP referral pathway and optimise it.Methods A two-cycle QIP was performed using the standard PDSA (Plan-Do-Study-Act) framework.Cycle 1 (August 2025): A retrospective audit of high risk patients was performed to identify, number of missed referrals and average wait times in the current model.Cycle 2 (September 2025): An intervention was implemented where fibroscan technicians directly emailed the booking office for all patients with high risk results, as agreed by the consultant body.Results In cycle 1 20% (n=4/20) of high risk patients were not referred for follow up. The median wait time for these patients from fibroscan to clinic appointment date was 182 days (mean 187.9 days) with no correlation between fibroscan result and appointment date.Following the implementation of our new pathway, in cycle 2, a 100% referral rate was achieved (n=25/25). The ­intervention also reduced the median waiting time by 49 days and the mean wait time by 61.2 days. Furthermore, the new pathway identified two patients who were at higher risk and an emergency appointment within 50 days was offered. However, there was no correlation otherwise between fibroscan result and time to appointment.Conclusion Moving from a GP dependent referral model to an in house referral model, eliminates the risk of patients being lost to follow up. Furthermore, it greatly reduces the waiting time to specialist clinic by removing intermediate administrative steps. This process has now been formally adopted as the new SOP.",
  "authors": [
    {
      "affiliations": [
        "Gloucestershire Hospitals, Leicester, United Kingdom"
      ],
      "name": "Mikesh Kansagra"
    },
    {
      "affiliations": [
        "Gloucestershire Hospitals, Leicester, United Kingdom"
      ],
      "name": "Coral Hollywod"
    },
    {
      "affiliations": [
        "Gloucestershire Hospitals, Leicester, United Kingdom"
      ],
      "name": "Margaret Hargreaves"
    }
  ],
  "title": "P112 QIP: improving referral reliability for high-risk GP fibroscan results",
  "uid": "7be034a6-b7c6-5c14-9cce-0c1463a8ded2"
}