Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2016 Jan;7(1):16-23.
doi: 10.1136/flgastro-2014-100491. Epub 2014 Dec 2.

Response to the NCEPOD report: development of a care bundle for patients admitted with decompensated cirrhosis-the first 24 h

Stuart McPherson  1 , Jessica Dyson  1 , Andrew Austin  2 , Mark Hudson  3
Affiliations
Review

Response to the NCEPOD report: development of a care bundle for patients admitted with decompensated cirrhosis-the first 24 h

Stuart McPherson et al. Frontline Gastroenterol. 2016 Jan.

Abstract

Recently, there has been a significant increase in the prevalence of chronic liver disease in the UK, and as a result, hospital admissions and deaths due to liver disease have also increased. The 2013 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) of patients with alcohol-related liver disease (ARLD) found that less than half the number of patients who died from ARLD received 'good care', and avoidable deaths were identified. In order to improve the care of patients admitted with ARLD, the NCEPOD report recommended that a 'toolkit' for the acute management of patients admitted with decompensated ARLD be developed and made widely available. As a result, we have developed a 'care bundle' for patients admitted with decompensated cirrhosis (of all aetiologies) to ensure that effective evidence-based treatments are delivered within the first 24 h. This care bundle provides a checklist to ensure that all appropriate investigations are undertaken when a patient with decompensated cirrhosis presents and provides clinicians with clear guidance on the initial management of alcohol withdrawal, infection, acute kidney injury, gastrointestinal bleeding and encephalopathy. The first 24 h are particularly important, as early intervention can reduce mortality and shorten hospital stay, and specialist gastroenterology/liver advice is not always available during this period. This review will discuss the care bundle and the evidence base behind the treatment recommendations made.

Keywords: ALCOHOLIC LIVER DISEASE; CHRONIC LIVER DISEASE; CIRRHOSIS.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The care bundle for decompensated cirrhosis.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. NHS liver care. NHS Atlas of Variation for People with liver disease: reducing the unwanted variation to increase value and improve quality. Right Care 2013:1–141.
    1. Thomson SJ, Westlake S, Rahman TM, et al. . Chronic liver disease--an increasing problem: a study of hospital admission and mortality rates in England, 1979–2005, with particular reference to alcoholic liver disease. Alcohol Alcohol 2008;43:416–22. - PubMed
    1. A Time to act: Improving Health and Outcomes in Liver Disease. The national plan for liver services (UK) British Society of Gastroenterology; 2009:1–52.
    1. Moreau R, Arroyo V. Acute on chronic liver failure: a new clinical entity. Clin Gastroenterol Hepatol Published Online First: 27 Feb 2014. - PubMed
    1. NCEPOD. “Measuring the Units”-a review of patients who died with alcoholic related liver disease. National Confidential Enquiry into Patient Outcome and Death (UK); 2013:1–25.