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IntroductionThe COVID 19 pandemic presented a challenge to UK hepatology services to devise new strategies to provide safe and effective outpatient care 1 Most patients could be managed remotely via virtual clinics but a cohort of patients with advanced liver disease need more direct monitoring and assessment 1 We describe a new hepatology ambulatory care unit set up during Covid-19 in a tertiary liver unit and demonstrate its outcomes MethodThe Hepatology Ambulatory Unit (HAU) was managed by two clinical registrars assessing patients face to face (F2F) with daily consultant supervision, supported by a registered nurse and two medical student volunteers acting as health care assistants F2F and virtual clinic reviews were offered Patients were referred into the HAU from local GPs, consultant referrals, following ward discharge and via a direct patient hot line triaged by two clinical nurse specialists ResultsData were collected from 23rd March to 23rd June 2020, comprising 136 patient encounters 86 patient encounters were completed in the F2F, the remainder in the virtual clinic 67% of patients were females and 56% had decompensated cirrhosis in the F2F clinic, with alcohol the most common aetiology (41%) The rest of the patients has a mixture of non- cirrhotic aetiology 14 patients needed paracentesis and 4 patients had infusions (blood or iron) Of the patients with cirrhosis, 83% had Child – Pugh Score B (7–9) and 14% had Child Pugh C (10–15), 56% had a UKELD between 49–60 Majority of the patients were followed up in the consultant led virtual clinic (65%) and HAU virtual clinic (25%) One patient underwent a liver transplant and 2 patients were referred to other specialist clinics 3 patients were discharged to the GP There were 2 patients admitted directly to the hospital with variceal bleed and sepsis None of the patients within the HAU clinic were infected with Covid-19, and there were no deaths ConclusionOur study shows that patients with advanced liver disease can be safely managed as outpatients in a well-supported closely-monitored unit Given reports of significantly increased Covid-19 related morbidity and mortality in patients with cirrhosis,1 we have demonstrated an alternative and effective ambulatory model of care, which can be retained to deliver safe care to this vulnerable patient group in the future Conflicts of InterestThe authors have no conflicts of interest or competing interests to disclose Referencehttps://www journal-of-hepatology eu/article/S0168-8278(20)30305-6/fulltext
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