A ward based ambulatory care model for patients with liver disease

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Initiative Type
Model of Care
Status
Deliver
Added
08 August 2023
Last updated
19 April 2024

Summary

The Gastroenterology and Hepatology departments at the Sunshine Coast University Hospital (SCUH) initiated a model of care for people with liver disease to address the high number of patients with cirrhosis presenting at the Emergency Department (ED). It also addresses the limited and timely access to the Paracentesis Day Unit and delay to outpatient appointments soon after discharge. 

This ward based ambulatory care model was developed to book patients into a two-bed bay in the gastroenterology ward for paracentesis, rapid clinical review, and critical infusions such as biologics and iron.

The unit is staffed by a 1.0 FTE clinical nurse and supported by a Hepatology Clinical Nurse Consultant (CNC) with administrative support.

The template allows for the booking of two large volume paracenteses per day and two 'rapid reviews' for recently discharged patients as well as slots for infusions.

Since its opening in July 2022 there have been 348 occasions of service. 

The service now has a dedicated funded nursing team.

 

Key dates
Jan 2021
Jun 2022
Implementation sites
Sunshine Coast University Hospital

Aim

  • to decrease the number of patients presenting to the Emergency Department needing urgent paracentesis. 
  • to decrease pressure on outpatient clinics for review of recently discharged patients. 

Benefits

Co-locating  ambulatory care with the same team that provides inpatient care:

  • is better for patients
  • reduces demand on outpatients
  • leads to less ED presentations
  • is popular with patients

Background

Chronic liver disease affects six million Australians, resulting in 7,000 deaths per year. The median age of death is in the mid 50s,  which comes a huge societal and financial cost. 

Between 25 and 30% of patients with cirrhosis are readmitted to hospital within 30 days, with either renal dysfunction or ascites requiring paracentesis. Additionally, in the EDs, the high number of people with cirrhosis presenting to EDs are often out of hours or over weekends leading to three day admissions. 

 

Solutions Implemented

  • a two-bed bay in the gastroenterology ward was established at SCUH that was currently unused
  • a nurse hotline was established for paracentesis
  • a rapid review within one week for recently discharged patients
  • the rapid reviews are scheduled for same time as consultant ward rounds

 

Evaluation and Results

  • 171 patients have undergone 'rapid review' on the ward by the Gastroenterology and Hepatology team, thereby saving 171 urgent outpatient appointments.
  • 156 patients have undergone large volume paracentesis - no patients known to the service have presented to the ED for drainage.
  • 129 rapid hepatology reviews have taken place - saving 129 outpatient appointments.
  • 77 biological infusions for acute severe ulcerative colitis have taken place, allowing early discharge of patients with ascites.
  • Patient feedback has been excellent.

Lessons Learnt

It would have benefitted us to partner with the business team prior to commencing the project in order to maximise activity based funding.

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Key contact

James O'Beirne
Clinical Director: Gastroenterology and Hepatology
Sunshine Coast University Hospital
07 52026873
James.OBeirne@health.qld.gov.au

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