Trainee Advanced Nurse Practitioner
Place of work
Gastroenterology/Hepatology Medicine, East Lancashire Hospitals NHS Trust
Mortality rates for liver disease continues to rise rapidly, being the third most common cause of premature death in England. The Northwest of England has 4,221 per 100,000 population under 75 mortality rates considered preventable, the worst region across England (Public Health England, 2015).
Despite the increase of preventable deaths, enquiries suggest that the acute care of patients with liver disease is poorly recognised, organised and implemented, resulting in patients receiving sub-standard care with avoidable deaths. Yet, such services can be improved at a relatively low cost to the National Health Service, whilst improving the clinical outcomes for patients (The National Confidential enquiry into patient outcome and death, 2013).
To innovate, implement and transform standards of liver care with an inspirational advanced practitioner led in-reach service. Aiming to undertake advanced clinical assessment, diagnostics and leadership for patients with liver disease, improving benchmarks of care provision, supporting positive patient progression to community services.
A Liver care bundle has been developed, incorporating best practice benchmarks to guide clinical teams/treatment plans required during the first 24 hours of admission. Patients will be triaged by the trainee advanced nurse practitioner and discussed with the duty designated on-call gastroenterology Consultant Monday-Friday 09:00-17:00.
Patients will be assessed by the trainee advanced practitioner in their clinical setting, reviewed daily with plans of on-going treatment until the patient is transferred to a Gastroenterology Ward or community setting, where outpatient hepatology follow up will be arranged.
The Donabedian model of evaluating quality of care (2005) evaluated the outcomes of the project. It reviewed the outcomes of a previously completed logic model following a three-monthly trial of the care bundle in practice including how many patients are seen within 48 hours of referral, 30-day readmission rate and if the trainee ANP has inspired teams to look at sustaining change, by evaluating a post intervention knowledge questionnaire.
The advanced practitioner led in-reach service to liver patients has improved quality of care, providing sustainable, inspirational, safe and effective services to the population.
Three key learning points
1. Mortality rates for liver disease have increased 400% since 1970, fivefold increase in mortality in people aged 65 years of younger.
2. Early identification and intervention of liver disease can improve survivability and promote a positive patient flow through their hospital journey, including follow up.
3. The need for a consistent approach of support from key stakeholders that will support the influence of the project is essential.
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