Adoption of a Clinical Assessment Service in Hepatology

P49 Table 1The impact of the clinical assessment service on the hepatology outpatient service2020 % Total ‘New appts 190 100% Total pts seen 134 71% Total DNAs 56 29% Total pts seen 134 100% Of pts seen & F/Up 113 84% Of pts seen & D/C’d 21 16% Total DNAs 56 100% DNA & Reschedule 33 59% DNA & D/C’d 23 41% 2022 % Total ‘New’ appts 181 100% Total pts seen 141 78% Total DNAs 40 22% Total pts seen 141 100% Of pts seen & F/Up 100 71% Of pts seen & D/C’d 41 29% Total DNAs 40 100% DNA & Reschedule 25 62.5% DNA & D/C’d 15 37.5% Since CAS has been introduced there have been several positive outcomes: in 2021, 18% of the referrals were appropriately repatriated to primary care with advice;30% of the referrals were managed without needing a face-to-face appointment;the waiting time reduced from 8 weeks to 5 weeks for a clinical review, and from 16 weeks to 15 weeks for a follow-up appointment;from 2020 to 2022 the proportion of patients discharged after the first clinical review has increased from 16% to 29%;specialist treatment is instigated more quickly;patients can be discharged following their first face-to-face visit as all information is to hand, it has eliminated unnecessary follow-up and has resulted in a clear and concise pathway to refer the patients into the service, with the diagnostic tests being performed at an earlier stage In summary CAS was introduced as an urgent service response to COVID-19 but we have identified key benefits and intend to continue it.

Real-life experience: sensitivity and specificity of nasal and saliva samples for COVID-19 diagnosis.

BACKGROUND: COVID-19 (coronavirus disease 2019) outbreak has spread rapidly around the world, continues to show its effect, and it is not clear how long it will continue. For the diagnosis of COVID-19, it is important to ensure the comfort of the patients and to protect the healthcare workers (HCWs) by reducing the use of protective equipment. AIMS: To evaluate or assess whether the samples taken by the patient for COVID-19 testing during this pandemic period can be used in real-life experience. METHODS: Three different samples (nasopharyngeal taken by the healthcare worker, nasopharyngeal, and saliva taken by the patient) from 132 patients were evaluated for the diagnosis of COVID-19. The sensitivity and specificity of the samples in the diagnosis of COVID-19 were compared with real-life experience. RESULTS: Paired analyzes were performed by comparing each sample taken by the healthcare worker with the sample taken by the patient. The sensitivity of the three samples (nasopharyngeal taken by the healthcare worker, nasopharyngeal, and saliva taken by the patient) in the diagnosis of the COVID-19 was (100%, 98.7%, and 96.1%, respectively) accepted to be accurate. CONCLUSIONS: The sample taken by the paramedic was compatible compared to the real-life experience for the samples taken by the patient in the COVID-19 pandemic period. During the pandemic that is unknown when it will end, this study demonstrated that taking the sample of the patient alone for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test is a beneficial approach to the protection of the healthcare worker, reducing the need for protective equipment, increasing the patient's comfort and rapid sampling.

P16 Transient elastography is underutilised in London hospitals and results in unnecessary endoscopic screening for oesophageal varices: a multi-site audit of practice

IntroductionThe Baveno VI consensus provides guidance on using non-invasive methods to identify patients with compensated advanced chronic liver disease (cACLD) who are unlikely to have clinically significant portal hypertension (CSPH). Patients with a platelet count of 150,000/Litre and a liver stiffness of 20kPa, assessed using transient elastography (TE), have a sufficiently low risk of variceal bleeding that they do not require variceal screening endoscopy to examine for oesophageal varices (OV) costing approximately £342 per procedure. This identifies potential substantial cost savings to healthcare systems and reduces risk to patients from unnecessary investigations. However, concordance with these guidelines, availability of TE and number of avoidable endoscopies is unknown.MethodRetrospective data collection from 10 sites across London, 6 teaching hospitals and 4 district general hospitals (DGH), over a 6 month period from 1st January to 30th June 2019 by reviewing oesophagogastroduodenoscopy (OGD) requests and analysing those with indications of ‘variceal screening’, ‘cirrhosis’, ‘liver disease’ or ‘variceal surveillance’. Patient platelet count and TE result within a year of OGD was recorded.ResultsData was collected for 353 endoscopies, 7 were excluded due to incomplete data and 89 due to decompensation at the time of endoscopy. 141 screening procedures were included. Endoscopic findings included: 74.5% no OV, 16.3% grade I OV and 9.2% ≥grade II OV or high risk stigmata. 49.7% did not have a recent TE (48.5% in teaching hospitals vs 52.4% in DGH). Of those who did have a recent TE result, 54 (76.1%) met the Baveno criteria for absence of CSPH, of whom 5 (9.3%) were found to have clinically significant varices. Median follow-up was 350.5 days and 0 of these patients subsequently bled. The performance of the Baveno criteria in this study was: sensitivity 64.3%, specificity 85.9%, positive predictive value 52.9% and negative predictive value 90.7%. Avoiding OGD in patients meeting Baveno criteria in this cohort would have potentially saved over £18000.DiscussionOur study shows that TE is not widely used for risk stratifying patients with cACLD across London prior to screening OGD. These simple non-invasive markers can achieve substantial cost savings, avoid exposing patients to unnecessary investigations and relieve pressure on endoscopy departments under increased strain due to the Coronavirus pandemic. Whilst a small proportion of OV will be missed, the bleeding risk in these is low with adequate follow-up. Availability and utilisation of TE for risk stratification in cACLD should be improved.