P42 Improving quality in liver services (IQILS) key performance indicators audit – an opportunity to implement change and improve patient care

Introduction The North Bristol Liver Unit (NBLU) 2018–2019 audit against the Improving Quality in Liver Services (IQILS) Key Performance Indicators (KPI) demonstrated good compliance but identified service improvement opportunities (table 1). The unit introduced twice daily AMU in-reach service, and improved the junior doctor training programme. We present re-audit after these service changes. Methods Patients with decompensated liver disease admitted to the gastroenterology ward between 01/08/2019 to 31/01/2020 were retrospectively identified. Electronic clinical records were interrogated to audit practice against the KPI recommending early specialist review, diagnostic ascitic tap in patients with ascites, administration of antibiotics in spontaneous bacterial peritonitis (SBP) and acute variceal bleeding. Results Over 6 months, 111 admissions were identified [67% male; mean age 55 years (range 31–88)] with most common aetiology being alcohol (81%) and NAFLD (12%). 85/92 (92.3%) patients (excluding admissions to other specialities etc.) received specialist review within 24 hours of admission (table 1). Diagnostic paracentesis was attempted in 53 patients (92.9%) with clinically significant ascites. All 4 patients (100%) with confirmed SBP received antibiotics and albumin within 12 hours of diagnosis. 19/20 (95%) and 11/12 (92%) patient with suspected and confirmed variceal bleeding respectively received prophylactic antibiotics. Discussion The North Bristol Liver Unit achieved over 90% compliance in all areas of IQILS KPI after implementing service improvement changes as a result of previous IQILS audit. This example emphasises the importance of critical self-assessment and engaging with national strategies to improve the care of patients with chronic liver disease.