Introduction Patients with chronic liver disease have several unplanned admissions during their disease trajectory.1 We undertook a service improvement initiative to develop a new care pathway for patients with ASLD.
Methods Six month pilot of 20 ASLD patients, (≥ 2admissions in last 12 months/’would you be surprised question’ with 6–12 mths prognosis/Childs C). Team of hepatologist, community matron, hepatology nurse specialist and service improvement facilitator developed ‘Durham Metrics’: quantitative and qualitative metrics (Figure) to evaluate ASLD pathway, on best practice,2 further refined with focussed discussion with stakehoders.
Results The metrics demonstrated that patient expereince pre-pilot was poor with multiple unplanned admissions and/or long waits, preferred place of death was not discussed; care was not co-ordinated, and quality of life was often poor as a result. All post-pilot metrics reported significant improvements. Use of alternative community services, and shared care plans led to improved efficiency. 83% achieved their preferred place of care and death contrast to nil pre pilot.
Conclusion Key metrics of performance are essential to evaluate service improvement project. The project metrics designed for this project were able to capture changes initiated by pathway however more data and time is needed to draw statistically valid conclusions.
National End of Life Care Intelligence Network 2012
Disclosure of Interest None Declared.
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