ABSTRACT
Introduction Emergency admission to hospital with decompensated liver disease (DLD) is a common medical presentation and carries a high mortality (10-20%)(1). Due to the nature of the disease and the associated complexities, the Close Monitoring Clinic (CMC) was set up to facilitate appropriate review post discharge with the aim of allowing early discharge, reducing re-admission rates and to provide education and support to patients. Aims and objectives To effectively manage and support patients with features of decompensated liver disease following discharge from the Gastroenterology Ward. The clinic also has capacity to review patients with other liver conditions who require close monitoring. Reduce the workload of medical staff and ensure patients are seen within 1-2 weeks post discharge in an attempt to reduce the readmission rate. Methods Clinic Commenced in 02/07/2019, half hour appointments were allocated to each patient. Nurses have completed clinical examination skills training and are independent prescribers. An MDT was introduced for discussion of patients with medical, pharmacy, nursing staff the following day when blood results available. It is planned the Palliative care team will join this MDT. It was initially thought that 4 clinic slots per week would be sufficient to accommodate all patients, however we had to increase this according to demand. Results To date (14/02/2022) there have been 500 appointments offered, only 42 appointments were not attended, giving an attendance rate of 92%. There have been 174 individuals offered appointments for the clinic, with a mean number of appointments per patient being 2 (range 1-28). The demographics show that 102 (58%) patients are male, the average age of those offered appointments was 58years old (range22-89). The aetiology of the need for an appointment can be seen in Chart 4. The time from discharge and appointment request (1-2 weeks) to time of actual appointment offered in a 20% sample is 85% of patients offered an appointment within the requested time frame. Conclusion The close monitoring clinic is an invaluable service, reducing the number of appointments required by medical staff. During the COVID-19 pandemic, we continued to see these patients face to face and if required arrange planned admissions mainly for ascitic drainage, reducing the workload on emergency care staff and GPs. These patients whilst in hospital are in a critical condition and often have had a near death experience have found the psychological support and the availability of telephone advice between appointments invaluable. The 'did not attend' rate is extremely low at 8%, which is incredible given the high number of patients with alcohol related aetiology.