PTU-134 Durham Pathway for Care of Patients with Advance Stage Liver Disease (ASLD)

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Care of patients with ASLD is poorly organised. This service improvement project aimed to develop a consistent pathway of care for ASLD patients.


Methods and results were iterative and included: 1. Track patient journey and Carer Experience: 2. Capture Activity Data from Clinical Coding: 3. Process mapping patient journey and Identify gaps in service provision 4. Design “Durham pathway” Figure for improving care of patients with ASLD with in reach liver service in community and developed range of both quantitative and qualitative metrics “Durham metrics” to monitor the effectiveness of the new pathway on patient outcomes and experience. 5. Engage relevant stakeholders and shared pathway 6. A 6 month Pilot of 20 ASLD patients with Community matron led inreach service. 7. Engage commissioners to fund ASLD pathway.


Pre-pilot patient and carer experience was poor with multiple unplanned admissions, preferred place of death was not discussed, majority of deaths in hospital, care was not coordinated, and quality of life of patient and carer was poor. All post-pilot metrics reported significant improvements. Improved efficiency evidenced by reduction in unplanned hospital admissions, increase use of alternative community services, with use of shared care plans. 83% of these achieved their preferred place of care and death in contrast to nil pre pilot.


This pathway worked for ASLD and needs wider evaluation and consideration of similar approaches to other groups.

Disclosure of Interest

None Declared.

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