P81 Improving discharge processes in decompensated liver cirrhosis patients with the use of a template to aid patient management both in and out of the hospital

<h3></h3> Decompensated liver cirrhosis is a common presenting complaint in hospital admissions. It encompasses multiple complications: ascites, variceal bleeding, jaundice and hepatic encephalopathy. These have a high in-hospital mortality rate (10%-20%). Each requires specialised acute and long-term management post-discharge. In our Trust we sought to use a discharge letter template adapted from The British Association for the Study of Liver Disease (BASL) and British Society of Gastroenterology (BSG) approved Decompensated Cirrhosis Discharge Bundle (DCDB). Previous studies have established that the use of DCDB improved care. Our aim was to determine if the introduction of this template improves discharge documentation and therefore improves patient care and facilitates outpatient management. Data was collected from electronic discharge letters of patients admitted under hepatology (269 patients). We identified patients with decompensated liver disease. Exclusion criteria: deceased patients during admission. Information was reviewed retrospectively for a two-month period prior to the introduction of a template. This template comprised of a 1-page document with pre-filled fields for doctors to edit when writing discharges. This was then disseminated face-to-face at a department teaching seminar along with posters to spread awareness in doctors’ offices. We introduced the following elements: follow-up date, aetiology, cause of decompensation, ascites, weight, electrolyte monitoring, diet, medications and treatment. Post intervention, data was collected over 2 months for analysis. A set of 11 elements were assessed before and after the intervention. These were categorised as pre-QIP (33 patients) and post-QIP (30 patients). A ‘Yes’ response was assigned to every element if mentioned in the discharge letter. A paired t-test was carried out which showed a statistically significant improvement in documentation (p=0.0089). In the following elements there was an observed increase in documentation – aetiology (75.8% to 90%), cause of decompensation (66.7% to 96.7%), ascites (69.7% to 80%), weight on discharge (24.2% to 36.7%), dietitians’ advice (6.1% to 26.7%), treatment (75.8% to 93.3%). High relative improvement seen – medication advice (33.3% to 76.7%) and Urea and Electrolytes monitoring (15.2% to 40%). A few showed decline – follow up date (30.3% to 26.7%) and spontaneous bacterial peritonitis or SBP (47.8% to 30%). Overall, the majority showed improvement in documentation. By improving discharge documentation and adapting the DCDB to our Trust’s practice, we are pro-actively improving the standard of care received by liver cirrhosis patients. This uptick in key elements being noted on discharge letters provides a comprehensive plan for post-discharge management of patients with more frequent monitoring.