RT Journal Article
SR Electronic
T1 OP-48 Liver supportive care – Utilisation of palliative care and care coordination to improve outcomes for liver disease patients
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP A29
OP A29
DO 10.1136/spcare-2024-ANZSPM.48
VO 14
IS Suppl 3
A1 Baig, Asma
A1 Qayyum, Sara
A1 Gofton, Cameron
YR 2024
UL http://spcare.bmj.com/content/14/Suppl_3/A29.1.abstract
AB Background Advanced liver disease (ALD) poses significant challenges, including high symptom burden, frequent hospital readmissions, and complex care needs for patients. Traditional models delay palliative care until end-of-life stages or End-Stage Liver Disease (ESLD), often missing opportunities for earlier intervention, holistic approach to care and ‘unmet needs’ that could improve patient outcomes (Valery et al., 2015).Aim The Liver Supportive Care program aimed to enhance the quality of life and health outcomes for patients with ALD with early integration of palliative care to manage symptoms, reducing hospital readmissions, and providing comprehensive, patient-centred care through a multidisciplinary approach.Methods Patients were identified from the Royal North Shore Hospital (RNSH) liver clinic or during hospital admissions for decompensated liver episodes. Eligible patients, meeting the SPICT criteria, were enrolled in the Liver Supportive Care program. The program included:Early integration of palliative careRegular follow-up via telehealth consultationsWeekly multidisciplinary team meetings (MDMs) involving hepatologists, nurses, dietitians, psychologists, and palliative care specialists to develop individualized patient care plansPatient reported outcome measures (PROMs) and quality of life assessments prior to palliative care reviews to tailor interventionsResults Since June 2023, the program has reduced 30-day readmissions from 42% to 12.12% and 90-day readmissions from 50% to 15.15%. With a clear discharge follow-up pathway, the program has reduced the average length of stay in hospital from 16.1 days (statewide) to approximately 4.6 days (within RNSH). Additionally, 48% of patients received early palliative care reviews, with 25% referred to community palliative care for ongoing management. Of the 18% of patients that have deceased since being on the program, 50% of the patients were known to community palliative care teams and care was escalated to a palliative care unit for End-of-Life care (EOLC) or to an acute hospital for management of reversible causes. The program has achieved significant cost savings and improved patient outcomes by reducing readmission rates and improved linkage to community services, as appropriate.Conclusion The Liver Supportive Care program demonstrates that early integration of palliative care and a multidisciplinary approach significantly improve health outcomes and reduce hospital readmissions for ALD patients. Its sustainable, scalable model offers a valuable framework for transforming chronic disease management, ensuring comprehensive and compassionate care that aligns with patient needs and healthcare efficiency.ReferenceValery PC, Powell E, Moses N, Volk ML, McPhail SM, Clark PJ, Martin J. Systematic review: unmet supportive care needs in people diagnosed with chronic liver disease. BMJ Open 2015;5(4):e007451. https://doi.org/10.1136/bmjopen-2014-007451