A review of patients who died with alcohol-related liver disease has been released by the National Confidential Enquiry into Patient Outcomes and Death (NCEPOD). The report calls for improvements in alcohol brief intervention (IBA), access to treatment, alcohol care teams and improved pathways across hospitals.
Download the full report Alcohol Related Liver Disease: Measuring the Units (2013) here or the Executive Summary.
The report reviews the process of care for patients who are treated for alcohol-related liver disease (ARLD), previously known as alcoholic liver disease (ALD). ONS data reports there were 8,748 alcohol-related liver disease deaths in the UK in 2011. It also highlights a statement from the Atlas of Liver Care for England of an "88% rise in age-standardised mortality from chronic liver disease, the only one of the major diseases which is still increasing, of which alcohol-related liver disease is one of the primary causes".
Principle recommendations include
- All patients presenting to hospital services should be screened for alcohol misuse. An alcohol history indicating the number of units drunk weekly, drinking patterns, recent drinking behaviour, time of last drink, indicators of dependence and risk of withdrawal should be documented. (All Doctors)
- All patients presenting to acute services with a history of potentially harmful drinking, should be referred to alcohol support services for a comprehensive physical and mental assessment. The referral and outcomes should be documented in the notes and communicated to the patient’s general practitioner. (All Doctors)
- Each hospital should have a 7-day Alcohol Specialist Nurse Service, with a skill mix of liver specialist and psychiatry liaison nurses to provide comprehensive physical and mental assessments, Brief Interventions and access to services within 24 hours of admission
- A multidisciplinary Alcohol Care Team, led by a consultant with dedicated sessions, should be established in each acute hospital and integrated across primary and secondary care. (Medical Directors)
- All patients admitted with decompensated alcohol related liver disease should be seen by a specialist gastroenterologist / hepatologist at the earliest opportunity after admission. This should be within 24 hours and no longer than 72 hours after admission to hospital.(Consultants)
- Escalation of care should be actively pursued for patients with alcohol-related liver disease, who deteriorate acutely and whose background functional status is good. There should be close liaison between the medical and critical care teams when making escalation decisions.
A planned National Liver Strategy is still yet to materialise. See here for a 2012 presentation by Dr Martin Lombard who was appointed to lead on the strategy. See here for a NHS Choices video on liver disease.
The British Liver Trust have previously carried out campaigns to promote liver health including reducing alcohol misuse. A 60% rise in cases of Alcoholic Liver Disease (ALD) in young people over the last seven years was reported in the North East last year.
See here for NICE alcohol guidance and resources.
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