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?:abstract
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625 patients in the local areas have cirrhosis Prior to Covid-19 the NLLS performed on average 8 5 day-case ascitic drains per month In addition to 5 discharge clinic reviews, 20 cirrhosis surveillance reviews were conducted weekly The NLLS is also a source of telephone advice and support for patients, carers and health professionals The advent of Covid-19 resulted in major changes to the NLLS Routine cirrhosis surveillance clinics and scans were postponed All surveillance patients were informed in writing of the changes, advising telephone contact if experiencing liver related problems Essential face to face reviews continued in the liver discharge clinic with additional telephone slots to increase capacity Day-case drainage of ascites continued with extra capacity due to the reduction in other day unit activity Relaxation of clinical criteria for day-cases assisted in preventing inpatient admissions In the 4 month period March - June 2020, 23 patients received day-case ascitic drains (maximum of 8 drains per patient) A monthly average of 17 drains (total 68) demonstrates a 100% increase in pre Covid activity Only 1 day-case patient required admission to the ward as a consequence of NLLS leave 2 patients (8 6%) previously unable to commit to day-case services with chaotic lifestyles now engage on a fortnightly basis, also receiving support from the alcohol care team at the same visit Since mid-May all day-cases are Covid screened in advance, track and trace is facilitated with dedicated bed spaces, and to date no day-case related covid infections identified 230 Cirrhosis surveillance scans were due during this time, all cases were reviewed and 16 priority scans (6 9%) ordered for those at high risk of developing a Hepatoma, of which 5 patients (31 25%) declined to attend due to Covid-19 fears Liver discharge clinic weekly reviews have doubled from 5 to 10 with the introduction of additional telephone reviews Telephone contact to the NLLS has increased substantially, unfortunately no pre Covid figures are available 147 individuals, predominantly patients but also carers and health care professionals made contact between March - June 2020 The purpose for contact included treatment interventions (diuretic tapering, arranging admission), general liver advice, emotional support and reassurance The NLLS is an essential component of local liver services New ways of working has enabled continuation of outpatient and day-case care for the most vulnerable liver patients, thus preventing inpatient admissions during lockdown
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