Providing a nurse-led service for patients with liver disease

The hepatology department at the Hull University Teaching Hospitals NHS Trust provides care and treatment for patients with liver disease to a local population of more than 600 000. Historically, this was delivered by medical staff. The service was audited to identify areas requiring development, with the aim of improving care for patients with liver disease and reduce length of hospital stay. The findings were categorised into inpatient, outpatient and day-case services.

Inpatient length of stay was often prolonged, and readmissions were frequent. Patients with ascites requiring drainage were only managed as an inpatient episode and had a median length of stay of 4.5 days. There was infrequent use of the British Society of Gastroenterology (BSG) and the British Association for the Study of the Liver (BASL) Decompensated Cirrhosis Care Bundle, which led to under-investigation and delays in care.

The lack of a dedicated hepatology in-reach service resulted in some patients not receiving any specialist input and were managed in non-specialist wards, contributing to increased lengths of stay and mortality.