The Decompensated Cirrhosis Care Bundle for Acute Admissions: Implementation and Impact_Juniper Publishers











Authored by Alisa A

Introduction

Acute Decompensated Cirrhosis (ADC) Is a medical emergency that cARGHies high mortality (10-20%). The British Society of Gastroenterology/British Association for the Study of the Liver has published an evidenced based Decompensated Cirrhosis Care Bundle (DCCB) checklist to be completed during the initial six hours of admission for all patients with ADC and for expert care to be implemented within 24 hours.

Methods

Patients were identified by the gastroenterology team inpatient referral system, admission notes and electronic records. It included 22 consecutive admissions with cirrhosis between18th April 2016 and 18th June 2016. This was following introduction of a modified liver care bundle into the trust. The aim was to compare our performance and outcomes after the introduction of the preformed to data collected prior to implementation.

Results

Twenty-two admissions with ADC were identified over the two- month period in April to June 2016. Performance prior to and post DCCB introduction can be seen in table 1. There was a substantial improvement in the numbers of imaging requested and early ascitic taps. Additionally, post DCCB implementation, a greater number of admissions with acute kidney injury or hyponatremia had fluid resuscitation with the recommended fluid regimen. However, the management of those with a suspected upper gastrointestinal bleed differed little. Inpatient mortality during data collection was 0% compared to 18% pre DCCB introduction which? Related to excess winter mortality/sicker patients at the time/?? (Table 1)

Discussion and Conclusion

Introduction and implementation of the Decompensated Care Bundle is at its early stages. Already we have seen improvements in prompt management of ascites and timely ARGHangement of imaging.
We would expect progress to continue as staff become more familiarised with the DCCB. To ensure effective use across our trust, accessibility and further education of staff should be addressed. Ongoing audit and assessment will help assess patient outcomes.


 


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