P35 Improving clinical relationship between palliative care and hepatology services: a DGH experience.
Published Date: 18th June 2023
Publication Authors: Avades T, Black R, Shami N
Abstract
Introduction: Whilst there is evidence that mortality secondary to liver disease is increasing, there is failure to recognise this.1 Early palliative care involvement should be offered to patients with advanced liver disease (MELD >30, or Child Pugh Class C). Regular palliative care-liver disease MDTs improve care through increased recognition, but this model is not feasible in a district general hospital (DGH) with limited resources.
Methods: Hepatology and Specialist Palliative Care (SPC) services have worked collaboratively to improve the recognition of end-stage liver disease through inter-disciplinary education, clinical collaboration, regular SPC presence on the gastroenterology ward and a pilot of monthly MDT meetings. The use of end-of life key enablers for patients with liver cirrhosis was measured: Gold Standard Framework (GSF) registration, future care planning (FCP) conversations, and referral to SPC services. Data were collected retrospectively of 30 patients admitted with decompensated liver disease from Jan 2019-Jan 2022. We re-audited 29 patients admitted June 2022-Dec 2022 following collaborative working.
Results: From our initial audit, 83% patients died in hospital, and preferred place of death (PPOD) was not established in any of the cases. 0% patients were offered FCP discussions, and 48% were referred to SPC team. 40% patients were GSF registered, with 72% patients dying within one week of referral. The re-audit post collaborative working revealed that 41% patients had a documented PPOD, with 90% of patients being in their PPOD at time of death. 44% patients were GSF registered, and 41% patients had FCP conversations. of those GSF registered, 50% patients died within a week.
Avades, T.; Black, R.; Shami, N.; Maher, E.; Finnegan, C.; Dawson, K. (2023). P35 Improving clinical relationship between palliative care and hepatology services: a DGH experience. Gut. 72(Suppl. 2), pp.A63-A64. [Online]. Available at: https://doi.org/10.1136/gutjnl-2023-BSG.107 [Accessed 27 February 2024].
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