Newcastle Liver Unit

What were your project’s key outcomes and successes and how has it improved care for patients? Who was involved?

The key outcomes were initially the development and implementation of a care bundle for patients admitted with decompensated cirrhosis in Newcastle. Local audit showed that use of the bundle improved all aspects of patient care, for example:

• better documentation of alcohol consumption
• increase in patients having diagnostic ascitic taps
• better medical management of variceal haemorrhage.

Hospital stay was reduced by 25%. The bundle was developed by Dr Stuart McPherson, with input from Dr Steve Masson, Dr Jess Dyson and Dr Mark Hudson. The whole team was involved in implementation, particularly Dr Chris Dipper and Elaine Coghill who were key in getting the bundle firmly amended to be usual practice on the emergency admissions suite.

Subsequent successes included working with the British Society of Gastroenterology liver section and the British Association for the Study of the Liver to have the bundle endorsed.

Working in collaboration with colleagues in Sunderland (Dr Simon Cowlam) and Cornwall (Dr Hyder Hussaini), the bundle was implemented in these two hospitals. Audit in these centres also showed substantial improvement in patient care, with similar findings to Newcastle.

How can others replicate your learning and successes?

This simple care bundle is widely available for use in any hospital. A full description of how the bundle was implemented in the three hospitals is shown in the papers above. We would strongly encourage others to implement a cirrhosis care bundle in their hospital as there is no doubt that it improves patient care for patients who have complex medical needs and have a significant risk of dying during their admission.

How did you overcome any challenges?

The main challenge of the project was initially educating doctors and making them aware the bundle was available, particularly as junior doctors frequently rotate and in a large trust there are a lot of people who work in medicine. Shortly after its introduction, rates of use of the bundle were low, but with repeated education this increased to 90%. Once doctors had used the bundle they found it helpful so continued to use it. Use of the bundle is now firmly embedded in practice in our trust. Implementation was not easy and required hard work from the team to keep persevering with education, but the hard work paid off. 

What does winning the Excellence in Patient Care Award mean for your project and your team? What impact has it had?

Winning the award was fantastic and rather unexpected as there were several other excellent projects shortlisted. It provided a great boost to the team to be recognised for this work. Clearly winning the award is great publicity for the care bundle and we would like to see a cirrhosis care bundle used in every hospital in the UK to help improve the care of patients with liver disease.

Papers have been published describing the evidence base behind the bundle (McPherson et al. Frontline Gastroenterology 2016;7(1):16-23) and evidence of its impact on improving patients' care (Dyson et al. Alimentary Pharmacology and Therapeutics 2016; 44(10):1030-1038).

The RCP Excellence in Patient Care Awards 2018 will open later this summer.