{
  "abstract": "Introduction Ultrasound-guided liver biopsy is increasingly performed and is a low-risk day case procedure. In our centre, patients are recovered in endoscopy and discharge requires review by the on-call hepatology registrar, contributing to increased registrar workload, discharge delays, and variable discharge documentation quality. We aimed to develop and implement a nurse-led discharge pathway to reduce the frequency of registrar review prior to discharge, improve completeness of post-biopsy documentation, and reduce time to discharge (TTD) from biopsy.Methods We retrospectively reviewed all day case ultrasound-guided liver biopsies performed over sequential two-month periods across three PDSA cycles. Procedures were undertaken in radiology or in endoscopy. Baseline measures included frequency of hepatology registrar reviews, documentation completeness (pain score, analgesia use, mobilisation, observations, eating/drinking, dressing assessment, and procedural complications), and TTD, which includes a minimum four-hour post procedure monitoring requirement. Where there was no formal time of biopsy or time of discharge documented, the time-stamp on the electronic record was used.A structured nursing post-biopsy review proforma was introduced in the electronic record. During an initial pilot phase in cycles one and two, registrar review remained mandatory following completion of the nursing proforma. Nursing feedback was collected via an anonymous form and used to refine the proforma and develop a nurse led discharge standard operating procedure (SOP). In cycle three, nurse led discharge was implemented for patients scoring 0 on the proforma, with registrar review reserved for scores ≥1.Results Baseline data were collected from 31 patients, with subsequent cycles comprising 28, 28, and 22 cases, respectively. Proforma uptake improved across cycles from 0% at baseline to 75%, 82%, and 95%. The frequency of hepatology registrar reviews reduced from 100% at baseline to 9% following implementation of the nurse-led discharge proforma in cycle three. Completeness of post-biopsy documentation improved from 61% at baseline to 91%, 95%, and 98% across successive cycles. Mean TTD initially measured 5 hours 36 minutes and improved to 5 hours 19 minutes, 4 hours 49 minutes, and 5 hours 13 minutes across subsequent cycles. No readmissions or complications were identified following nurse-led discharges. Accuracy of calculated TTD remained a consistent limitation due to possible delays in documentation timing versus actual time of biopsy and discharge.Conclusion Implementation of a structured nursing post-biopsy review proforma and discharge pathway improved documentation quality, reduced hepatology registrar workload, and was associated with shorter discharge times. Ongoing evaluation will assess safety, sustainability, and potential wider implementation across biopsy settings.",
  "authors": [
    {
      "affiliations": [
        "Barths Health NHS Trust, London, United Kingdom"
      ],
      "name": "Sumayya Asia Begum"
    },
    {
      "affiliations": [
        "Barths Health NHS Trust, London, United Kingdom"
      ],
      "name": "Madeleine Sharpe"
    },
    {
      "affiliations": [
        "Barths Health NHS Trust, London, United Kingdom"
      ],
      "name": "Georgina Kerry"
    },
    {
      "affiliations": [
        "Barths Health NHS Trust, London, United Kingdom"
      ],
      "name": "Vikram Sharma"
    },
    {
      "affiliations": [
        "Barths Health NHS Trust, London, United Kingdom"
      ],
      "name": "Arnel Alve"
    }
  ],
  "title": "P285 Developing a nurse led discharge pathway for patients post liver biopsy",
  "uid": "c4ad2233-b4f3-55ea-9636-7d63df46be4e"
}