P51 Decompensated cirrhosis – a timely intervention?

<h3></h3> The 2013 NCEPOD report highlighted suboptimal care and missed opportunities in patients with decompensated alcohol related liver disease and prompted development of the BSG-BASL care bundle. This aims to improve patient care through timely delivery of appropriate, evidence based management and consequently reduce mortality. In Leeds Teaching Hospitals Trust, an electronic form of the care bundle exists on PPM Software (electronic patient record). This acts as an accessible, structured and essential aid to guide junior doctors. Lack of awareness has resulted in poor completion rates. <h3>Aim</h3> To deliver interventions aimed at improving compliance with the electronic bundle (e-bundle) when admitting patients with decompensated chronic liver disease (D-CLD). <h3>Methods</h3> Electronic health records of patients admitted with D-CLD between August-September 2023 were retrospectively reviewed for care bundle completion. We collected data on the grades of doctor clerking the patients and completing the bundle and the time from clerking to care bundle completion. Junior doctor interviews highlighted lack of awareness of the existence of the e-bundle as a potential barrier to completion. Following analysis, posters and verbal reminders were introduced to raise awareness of the existence of the electronic form. We then re-audited the same patient group from October-November 2023, using the same parameters. Subsequent analysis led us to target the registrar population and the new rotational junior doctors with email prompts before and after starting their placement. We completed another cycle of the audit from December 2023- January 2024. <h3>Results</h3> 203 patients were admitted; 35 (17%) had the e-bundle completed. Bundle completion rates improved after our first intervention from 9% (6) to 27% (20), however this was not sustained and dropped to 13% (9) after the second intervention. 70% (143) of the patients admitted were clerked by a specialty registrar. An increase in the number of bundles being completed by the junior team, either in support of a registrar clerking or in their own clerking improved from 33% to 44% over the 6 months. 80% of patients had the e-bundle completed within 6 hours of the admission. Our audit identified difficulties in sustaining good compliance with the e-bundle despite several interventions. Frequent changes in the junior doctor work-force pose an on-going challenge in effective implementation of the e-bundle. Our audit highlighted the importance of rigorous departmental induction emphasising the existence of the bundle and the importance of completion in a timely manner. Only the above measures will result in sustained implementation rates. <h3>References</h3> https://www.bsg.org.uk/clinical-resource/bsg-basl-decompensated-cirrhosis-first-24-hours https://www.ncepod.org.uk/2013report1/downloads/MeasuringTheUnits_FullReport.pdf