P83 Ambulatory and home-based hepatology care; a novel pathway for the integrated management of patients with liver disease

<h3>Background</h3> Hospital admissions and deaths due to the complications of chronic liver disease in the UK continue to rise.¹ Day-case care bundles and increased community care have been suggested to mitigate this surge in demand,² however hepatology day-case and ambulatory services offering alternatives to inpatient admission are not well described. A clinical nurse specialist led Hepatology Ambulatory Unit (HAU) has been active since September 2020 at the Oxford Liver Unit. Due to increasing demand for HAU, a hepatology at home service has been piloted to manage selected patients in the home environment. We performed an evaluation of HAU over the last 3 years to understand the demand for and nature of clinical activity delivered over time and describe the first patients referred and managed in a novel hepatology at home service. <h3>Methods</h3> Encounter level data on clinical activity undertaken on the HAU, John Radcliffe Hospital, Oxford, was collected prospectively (April 2021 - March 2024). Patient level data was collected from an in-depth retrospective review of the electronic record of all HAU encounters between October 2023 and March 2024. Data on patients referred to the hepatology at home pilot from May 2024 were collected prospectively. <h3>Results</h3> The number of HAU encounters has grown between April 2021 and March 2024 (year 1 n=1548, year 2 n=1570 +1.4%, year 3 n=1660 +5.7%). Encounters for clinical review and basic diagnostics have increased (year 1 n=475, year 2 n=663 +39.6%, year 3 n=741 +11.8% increase). There were 809 HAU encounters for 267 patients between October 2023 and March 2024. The most common interventions were clinical assessment (n=384/809, 47.5%), venesection (n=345/809, 42.6%) or paracentesis (n=84/809, 10.4%). The majority of the 165 non-venesection patients had cirrhosis or non-cirrhotic portal hypertension (n=114/165, 69.1%), with ascites and/or peripheral oedema (n=85/114, 74.6%) as the most common complication. From May 2024 seven patients were referred and managed via the hepatology at home pilot. All had cirrhosis complicated by ascites and/or peripheral oedema and were managed at home with blood tests, clinical review and point of care ultrasound. Ongoing management was discussed at bi-weekly meetings with input from the hepatology and hospital at home teams. <h3>Conclusions</h3> Clinical activity on HAU is increasing, with increased referrals for clinical assessment of patients with high levels of complexity and acuity. Hepatology at home is an alternative way of managing a select group of patients, where demand for hepatology ambulatory services is high. <h3>References</h3> Office for Health Improvement and Disparities. Liver disease profile, April 2024 update [Internet]. UK Government; 2024 [cited 2024 Jun 3]. Available from: https://www.gov.uk/government/statistics/liver-disease-profile-april-2024-update/liver-disease-profile-april-2024-update Williams R, Aithal G, Alexander GJ, Allison M, Armstrong I, Aspinall R, et al. Unacceptable failures: the final report of the Lancet Commission into liver disease in the UK. The Lancet. 2020 Jan;395(10219):226–39.