{
  "abstract": "Introduction The Regional Liver Unit at the Royal Victoria Hospital provides tertiary hepatology care for patients across Northern Ireland. Ongoing pressure on inpatient bed capacity frequently results in cancellation of elective admissions for essential cancer treatments and therapeutic procedures. While sameday admission pathways have been established to reduce length of stay, additional strategies are needed to increase capacity without expanding the bed base. In November 2025, an ambulatory service—the Hepatology Hot Clinic—was introduced. The service was developed through reallocation of existing clinical resources and was therefore cost neutral. The aims were to:facilitate early supported discharge from the ward.enable rapid assessment of urgent general practitioner (GP) referrals potentially requiring admission.provide timely review of existing outpatients with abnormal clinical results.Methods The clinic operates twice weekly with six appointments per clinic. Referrals are vetted by a consultant hepatologist and scheduled within one week of referral. A retrospective review of the first six weeks was undertaken, evaluating referral source, indication for attendance, diagnoses, and clinical outcomes.Results Of 72 available appointments, 52 were utilised by 48 patients, with four patients attending on two occasions.Eighteen patients (35%) were seen directly from etriage or referral (primary care or other specialties); all were managed through ambulation without the need for admission. Eight of these (44%) were discharged from ongoing care.4 patients (7%) required admission or further day case interventional radiology – attendance at hot clinic avoided an ED attendance in each case.Seventeen patients (33%) were referred from hepatology outpatient clinics for enhanced monitoring. Thirteen patients (25%) were reviews post hepatology admission, thereby facilitating early, safe discharge. Overall discharge rate from hepatology services following hot clinic attendance was 31%.40 of 48 patients (83%) achieved their intended visit outcome, including improvement in biochemical parameters and safe titration of diuretic therapy.Conclusion Early experience with the Hot Clinic demonstrates that a costneutral ambulatory service, delivered through reallocation of existing resources, can support earlier discharge, reduce admissions and improve patient flow within a tertiary hepatology service. Accepting appropriate referrals from the Emergency Department represents an important next step and may further reduce unnecessary admissions and prolonged outpatient waiting times.",
  "authors": [
    {
      "affiliations": [
        "Belfast Health And Social Care Trust, Belfast, United Kingdom"
      ],
      "name": "Patrick MacAllister"
    },
    {
      "affiliations": [
        "Belfast Health And Social Care Trust, Belfast, United Kingdom"
      ],
      "name": "Brooke Layard"
    },
    {
      "affiliations": [
        "Belfast Health And Social Care Trust, Belfast, United Kingdom"
      ],
      "name": "Neil McDougall"
    },
    {
      "affiliations": [
        "Belfast Health And Social Care Trust, Belfast, United Kingdom"
      ],
      "name": "Hannah McDowell"
    }
  ],
  "title": "FP21 Development of a hepatology ‘hot clinic’: a cost-neutral ambulatory model to improve patient flow, reduce bed pressures and expedite care",
  "uid": "99afdaa8-5e0b-542c-9747-3a343f7972ab"
}