Implementation of a 'care bundle' improves the management of patients admitted to hospital with decompensated cirrhosis.
Since 1970, there has been a 400% increase in liver-related deaths due to the increasing prevalence of chronic liver disease in the United Kingdom (UK). The 2013 UK National Confidential Enquiry into Patient Outcome and Death report found that only 47% of patients who died from alcohol-related liver disease received 'good care' during their hospital stay.



To develop a 'care bundle' for patients with decompensated cirrhosis, aiming to ensure that evidence-based treatments are delivered within the first 24 h of hospital admission.



This work gives practical advice about how to implement the bundle and examines its effects on patient care at three National Health Service Hospital Trusts in the UK by collecting data on patient care before and after introduction of the bundle.



Data were collected on 228 patients across three centres (59% male, median age 53 years). Alcohol-related liver disease was the aetiology of chronic liver disease in 85% of patients. The overall mortality rate during hospital admission was 15%. The audits demonstrated improvements in patient care for patients with a completed care bundle who were significantly more likely to have a diagnostic ascitic performed within the first 24 h (P = 0.020), have an accurate alcohol history documented (P < 0.0001) and be given antibiotics as prophylaxis against infection following a variceal haemorrhage (P = 0.0096). In Newcastle, the bundle completion rate increased from 25% to 90% during the review periods.



The introduction of a care bundle was associated with increased rates of diagnostic paracentesis and antibiotic prophylaxis with variceal haemorrhage in patients with decompensated cirrhosis.
Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
J K
JK
Dyson
City Hospitals Sunderland, Sunderland, UK.
P
P
Rajasekhar
City Hospitals Sunderland, Sunderland, UK.
A
A
Wetten
Royal Cornwall Hospital NHS Trust, Cornwall, UK.
H H
HH
Ashraf
Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
S
S
Ng
Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
S
S
Paremal
Royal Cornwall Hospital NHS Trust, Cornwall, UK.
M F
MF
Baqai
Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
C A
CA
Lamb
Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
S
S
Masson
Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
M
M
Hudson
Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
C
C
Dipper
City Hospitals Sunderland, Sunderland, UK.
S
S
Cowlam
Royal Cornwall Hospital NHS Trust, Cornwall, UK.
H
H
Hussaini
Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. stuart.mcpherson@nuth.nhs.uk.
S
S
McPherson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004932:Esophageal and Gastric Varices / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D064872:Patient Care Bundles; D006113:United Kingdom
D000900:Anti-Bacterial Agents
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