124 Future care planning in advanced liver disease

<h3>Introduction</h3> Future Care Planning (FCP) is a proactive, patient-centred approach that promotes autonomy, reduces unnecessary interventions, and minimizes unscheduled hospital admissions. Patients with advanced liver disease have a poor prognosis and face a high risk of acute complications such as gastrointestinal bleeding, ascites, infection, and encephalopathy. This study audited the documentation of FCPs for advanced liver disease patients discharged from Gastroenterology wards at Glasgow Royal Infirmary. <h3>Methods</h3> A retrospective review of clinical portal and scanned case notes for 20–25 discharged patients selected from the Glasgow Ambulatory Liver Service (GLASS) records was done in each cycle. We assessed diagnoses, prognostic scores, and discharge documentation for the presence of FCPs in electronic records or discharge letter. <h3>Results</h3> Both audit cycles had a similar gender distribution, with mean ages of 57 in Cycle 1 and 56 in Cycle 2. Alcohol-related liver disease was the most frequent diagnosis (70% cycle 1 and 80% cycle 2). Prognostic scores (Childs-Pugh and UKELD) were documented in 60% of Cycle 1 patients and 88% of Cycle 2 patients. No patients across either cycle had an electronic FCP documented on discharge despite an educational session on electronic FCP being delivered after cycle 1. Readmission rates within six months were 30% in Cycle 1 and 52% in Cycle 2. 36% of patients reviewed retrospectively in cycle 2 had died within the 6 months since the admission studied as part of the evaluation. <h3>Conclusion</h3> This service evaluation shows that future care planning remains challenging in patients with end stage liver disease despite this cohort of patients having a high readmission and mortality rate. A ‘Surprise Question’ has been added to the Liver MDT post cycle 2, and more communication training around FCP discussions planned. Further considerations of barriers to FCP and how best to support this patient group is also required.