title: Response to the NCEPOD report: development of a care bundle for patients admitted with decompensated cirrhosis-the first 24 h.
abstract: Recently, there has been a significant increase in the prevalence of chronic liver disease in the UK, and as a result, hospital admissions and deaths due to liver disease have also increased. The 2013 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) of patients with alcohol-related liver disease (ARLD) found that less than half the number of patients who died from ARLD received 'good care', and avoidable deaths were identified. In order to improve the care of patients admitted with ARLD, the NCEPOD report recommended that a 'toolkit' for the acute management of patients admitted with decompensated ARLD be developed and made widely available. As a result, we have developed a 'care bundle' for patients admitted with decompensated cirrhosis (of all aetiologies) to ensure that effective evidence-based treatments are delivered within the first 24 h. This care bundle provides a checklist to ensure that all appropriate investigations are undertaken when a patient with decompensated cirrhosis presents and provides clinicians with clear guidance on the initial management of alcohol withdrawal, infection, acute kidney injury, gastrointestinal bleeding and encephalopathy. The first 24 h are particularly important, as early intervention can reduce mortality and shorten hospital stay, and specialist gastroenterology/liver advice is not always available during this period. This review will discuss the care bundle and the evidence base behind the treatment recommendations made.
authors.affiliation: Liver Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: McPherson
authors.affiliation: Liver Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Dyson
authors.affiliation: Department of Gastroenterology, Derby Hospitals NHS Foundation Trust, Derby, UK; British Society of Gastroenterology, Liver Section, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Austin
authors.affiliation: Liver Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; British Association for the Study of the Liver, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Hudson
keywords: ALCOHOLIC LIVER DISEASE; CHRONIC LIVER DISEASE; CIRRHOSIS
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