P81 Development of a regional pathway to help standardise regional differences identified in assessment and escalation of patients admitted with acute liver decompensation and acute on chronic liver failure (analysis across three centres)

<h3>Introduction</h3> Acute on chronic liver failure (ACLF) is an entity encompassing acute decompensation events with severity of organ failure and is associated with high short-term mortality. We retrospectively reviewed clinical practice within our tertiary centre and two secondary level centres in the region to help guide further areas for improvement in line with the recent publication of EASL clinical practice guidelines on ACLF.¹ <h3>Methods</h3> Retrospective review of electronic and paper records of all decompensated liver disease admissions to emergency department (transfers to tertiary centre were excluded) over a 6-month period across three sites between 31st January 2023 and 31st July 2023 focussing on progression to ACLF, level of care, co-morbidity and timing of review and escalations. Demographic, clinical and biochemical parameters were analysed. Statistical analysis used descriptive statistics, Kruskal-Wallis for group comparisons and Chi-square to compare frequency of categorical values. A p value &lt; 0.05 was considered statistically significant. <h3>Results</h3> Data was collected on n=94 total patients across three sites presented in table 1 (56% male; mean age 58; alcohol aetiology 69%); on admission 81% defined as acute decompensation and 19% ACLF. There was no significant difference between the different centres and factors such as age (p=0.72), ECOG PS (p=0.8), admission MELD (p=0.56) and Child Pugh score (p=0.43). The majority (64%) of admissions were after 5pm. Significant variations were identified in factors such as completion of decompensated cirrhosis care bundle (p&lt;0.0001), transfer to gastroenterology ward within 48 hours of admission (p&lt;0.044), admission to ICU (p=0.015), overall mortality (p=0.025) and follow-up within 2 weeks of discharge (p=0.026). <h3>Conclusion</h3> Addressing variations to admission care and escalation pathways are pivotal to standardising care. We have developed a regional pathway for patients with decompensated cirrhosis, aiming to ensure that recognition and escalation is timely and consistent irrespective of geography. <h3>Reference</h3> Moreau, <i>et al.</i> EASL Clinical Practice Guidelines on acute-on-chronic-liver failure. <i>J Hep</i> 2023.