Use of clinical practice guidelines to promote best practice when managing clinical interventions for liver transplant candidates.
BACKGROUND
Limited organ availability and an increasing demand for organ transplantation has extended transplant waiting times and thus increased morbidity and mortality for potential recipients on waiting lists. The Queensland Liver Transplant Service identified use of clinical practice guidelines developed from evidence-based practice as a strategic clinical management/workflow tool that could improve clinical outcomes for patients awaiting liver transplant.


METHODS
An extensive review of publications related to the management of advanced liver disease in potential transplant recipients was undertaken and the supporting evidence was identified. In all stages of development of the guidelines, the multidisciplinary collaborative team of clinicians used recommended principles from The Appraisal of Guidelines, Research and Evaluation collaboration. The liver transplant recipient coordinator acted as facilitator for the project, identifying positive factors and resolving obstacles.


RESULTS
Key focus areas in optimizing medical management before liver transplant were identified with the aim of preventing disease progression and complications that would jeopardize patients' outcome. Clinical practice guidelines were developed for each key area to optimize care by promoting appropriate timing of clinical interventions.


CONCLUSIONS
Practices that required change to comply with identified best practice were investigated, and clinical practice for the outpatient medical management of potential liver transplant recipients with chronic liver disease were developed collaboratively. These guidelines have been accepted and are being implemented within the gastroenterology and hepatology department at the Princess Alexandra Hospital.
Jarrett
Maree
M
Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Queensland 4102, Australia. maree_jarrett@health.qld.gov.au
D000465:Algorithms; D019985:Benchmarking / Q000458:organization & administration*; D002908:Chronic Disease; D003663:Decision Trees; D018450:Disease Progression; D055317:Evidence-Based Practice; D020065:Hepatopulmonary Syndrome / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000517:prevention & control; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000517:prevention & control; D017093:Liver Failure / Q000150:complications / Q000401:mortality / Q000517:prevention & control* / Q000601:surgery; D016031:Liver Transplantation; D008403:Mass Screening; D009017:Morbidity; D020380:Needs Assessment; D010348:Patient Care Team / Q000458:organization & administration; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods* / Q000592:standards; D011793:Queensland / Q000453:epidemiology; D009927:Tissue and Organ Procurement / Q000458:organization & administration; D014850:Waiting Lists