P92 Transforming cirrhosis surveillance through implementation of the early diagnosis support worker role the chester experience

<h3>Introduction</h3> National guidelines recommend that patients with cirrhosis undergo 6-monthly liver ultrasound scans and regular clinical reviews to detect hepatocellular carcinoma (HCC) at an early, treatable stage. However, less than half of eligible patients receive surveillance, and 70% of HCC is untreated.^{1 2} The Cancer Alliance initiated a project in 2023 to enhance HCC surveillance across the UK, they recommended Early Diagnosis Support Workers (EDSWs) to strengthen surveillance programs and improve patient engagement. The Countess of Chester Hospital (COCH) participated in this initiative, employing an EDSW in April 2024. This paper outlines the service improvements achieved and evaluates the effectiveness of this model. <h3>Method</h3> Prior to 2024, COCH lacked a comprehensive database of cirrhosis patients requiring HCC surveillance, and systems for clinic and ultrasound recalls were inadequate. The EDSW utilised hospital records to compile a robust database of eligible patients. Overdue or missed clinical reviews were identified, and patients with poor attendance were supported through transport assistance, education, and bespoke communication. Standardised HCC scan results letters were developed, reducing clinician administrative time and ensuring timely patient updates. Data on the HCC surveillance program was regularly submitted to the Cancer Alliance, and information on patients diagnosed with primary liver cancer before and after the intervention was obtained from the Somerset Cancer Registry. <h3>Results</h3> In April 2024, a comprehensive local review identified 351 cirrhosis patients eligible for surveillance at the Countess of Chester, with 100 overdue scans or clinical reviews, all of which were promptly reinstated. By April 2025, the cohort had increased to 491 patients, with over 90% attending their scans and having 6 monthly clinical reviews. In 2023, only 9% patients diagnosed with liver cancer were in HCC surveillance and only 2 received treatment. In 2024, 8 out of 12 patients were on surveillance, and 9 were offered treatment, see table 1 for figures. The EDSW’s use of standardized result letters reduced clinician administrative time and contributed to positive feedback captured by patient questionnaires about the service. <h3>Conclusion</h3> The implementation of the EDSW role at COCH has enhanced the efficiency and safety of HCC surveillance. It has improved patient engagement, timely scans, early cancer detection and increasing treatment opportunities. This model demonstrates substantial value in improving patient access to care and reducing administrative burdens on clinical staff. The increasing number of cirrhosis patients in Chester requiring ongoing care underscores the need for continued sustainability of the EDSW model. <h3>References</h3> Mansour D,<i> et al.</i> British society of gastroenterology best practice guidance: outpatient management of cirrhosis – part 1: compensated cirrhosis. <i>Frontline Gastroenterology.</i> 2023;14(6):453–461. NHS England (2024) <i>Hepatocellular carcinoma surveillance: minimum Standards.</i> Available at: http://www.england.nhs.uk/long-read/hepatocellular-carcinoma-surveillance-minimum-standards/(Accessed: 01 June 2025).