Introduction Assessment for orthotopic liver transplantation (LT) traditionally requires admission to hospital. In 2010, the liver unit at the University Hospital Birmingham (UHB) launched the first UK-based out-patient assessment programme (OPA). This study aims to describe our experience, with specific focus on feasibility, efficacy, cost-effectiveness and patient satisfaction.
Methods Patients undergoing elective LT assessment were retrospectively analysed between June 2010 and April 2011. Data collected included patient demographics/clinical features, LT assessment parameters, duration to listing/LT and reasons for LT refusal. An extensive cost evaluation was performed on both in- and out-patient LT assessment, including clinical tests, staffing and hospital facilities utilised. Patient satisfaction questionnaires were collected prospectively from April 2011 to November 2011.
Results 179 patients underwent LT assessment. 87/94 successfully completed OPA, with seven converted to in-patient LT assessment (IPA) due to pre-existing co-morbidity including refractory ascites and hepatic encephalopathy. All patients referred for OPA were triaged 2 weeks prior to the assessment to ensure suitability. 92 patients successfully underwent IPA. 66/87 OPAs were subsequently listed for LT (median duration from OPA to listing 3 days [0–306], of which 37/66 received a cadaveric graft. The reasons for OPAs not listed include: too early for LT (50.0%), contraindication to LT (42.9%) and patient refusal (7.1%). 53/92 IPAs were listed, mean duration 4 days [1–39], of which 34/53 were transplanted. Reasons for IPAs not listed: contraindication to LT (48.2%), too early for LT (44.4%) and patient refusal (7.4%). A single IPA costs on average £14 441 as compared to £11 494 for an OPA. Overall satisfaction (mean score 9.6/10; 10=very satisfied, 1=very dissatisfied) and convenience (7.9/10) for patients undergoing OPA were high.
Conclusion We describe for first time that OPA is feasible, efficient and cost-effective. With increasing demand on hospital beds in the UK National Health Service, such a programme has the potential to reduce the burden on LT in-patient services.
Competing interests None declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.