63 Improving advance care planning for inpatients with chronic liver disease – a quality improvement project on the gastroenterology ward at Royal Oldham Hospital

Introduction Liver disease is the third biggest cause of premature death in working age adults, and is the only major disease group in the UK where mortality is rising. It is acknowledged that good quality health care is lacking in liver disease patients where outcome is uncertain. The result is that over 70% of patients with liver disease die in hospital, with patients often having multiple admissions in the last year of life, a high symptom burden and poor access to palliative care services. Methods We identified patients with uncertain prognosis using Child Pugh score and clinical acumen. We implemented three PDSA cycles: Education for ward team around advance care planning(ACP) Introduction of liver disease admission proforma to help identify those with uncertain prognosis and prompt initial discussions and escalation decisions Commencing a weekly MDT to support decision making particularly regarding GSF score and ceiling of treatment including escalation status and readmission Results Overall ACP was assessed as realistic conversations with patient and relatives, patient's wishes and preferred place of care(PPC)/preferred place of death(PPD), and escalation status. Each component was assessed as appropriate for each patient before deciding if there was an individualised overall ACP. Initial data showed only 5%(n=21) patients having an ACP which improved to 55%(n=20) following introduction of the MDT. A discussion around patient's wishes and PPC/PPD were the most common omissions from ACP after interventions. Conclusion Liver disease requiring hospital admission carries a poor prognosis and therefore ACP is an important aspect of inpatient care. This project has shown a strategy for integration of ACP earlier for patients with liver disease alongside active treatment. This has been somewhat user-dependent, and still requires further development. Ongoing work is therefore needed to embed ACP into practice for all to be a sustainable intervention in a busy inpatient setting.