Improving access to inpatient palliative care for patients with end-stage liver disease: a quality improvement project
File(s)
Accepted version
Author(s)
Possamai, Lucia
Ward, Elvina
Type
Journal Article
Abstract
Background: End-stage liver disease (ESLD) is a terminal diagnosis with a
poor prognosis and an accelerating mortality rate in the UK. Limited
research suggests patients with ESLD have unmet palliative care (PC)
needs, likely due to various factors, including difficulty predicting
prognosis and lack of clear specialist palliative care (SPC) referral criteria.
This quality improvement (QI) project aimed to assess and improve
access to PC for inpatients with ESLD and unmet PC needs over a six month period using a novel intervention incorporating the Supportive and
Palliative Care Indicators Tool for Liver Disease (SPICT).
Methods: The project was conducted at a tertiary centre between 2020
and 2022 with three data cycles; one baseline measurement and two
Plan-Do-Study-Act (PDSA) cycles. PDSA Cycle 1 involved regular
screening of inpatients using the SPICT to trigger SPC referral. PDSA
Cycle 2 also involved screening using the SPICT, but instead to prompt
multidisciplinary meeting (MDM) discussion between hepatology and SPC
teams. Outcome measures reflecting holistic aspects of PC were assessed
across all cycles.
Results: PDSA Cycle 1 demonstrated a significant reduction in patients
receiving no PC measures (67% to 26%, p: <0.001) and increased SPC
input (32% to 52%, p: 0.04). Community PC referrals also rose
significantly (13% to 39%, p: 0.01).
PDSA Cycle 2 failed to improve measures compared to baseline. Only
42% of eligible patients were discussed in the MDM. Most agreed plans
were implemented, but only a minority included SPC review, community
PC referral, or advanced care planning.
Conclusion: Patients with ESLD continued to have unmet PC needs
despite implementing an intervention based on expert guidance. PDSA
Cycle 1 demonstrated some significant, positive impacts, supporting the clinical utility of the SPICT, but within the context of a small, single centre QI project with methodological limitations.
poor prognosis and an accelerating mortality rate in the UK. Limited
research suggests patients with ESLD have unmet palliative care (PC)
needs, likely due to various factors, including difficulty predicting
prognosis and lack of clear specialist palliative care (SPC) referral criteria.
This quality improvement (QI) project aimed to assess and improve
access to PC for inpatients with ESLD and unmet PC needs over a six month period using a novel intervention incorporating the Supportive and
Palliative Care Indicators Tool for Liver Disease (SPICT).
Methods: The project was conducted at a tertiary centre between 2020
and 2022 with three data cycles; one baseline measurement and two
Plan-Do-Study-Act (PDSA) cycles. PDSA Cycle 1 involved regular
screening of inpatients using the SPICT to trigger SPC referral. PDSA
Cycle 2 also involved screening using the SPICT, but instead to prompt
multidisciplinary meeting (MDM) discussion between hepatology and SPC
teams. Outcome measures reflecting holistic aspects of PC were assessed
across all cycles.
Results: PDSA Cycle 1 demonstrated a significant reduction in patients
receiving no PC measures (67% to 26%, p: <0.001) and increased SPC
input (32% to 52%, p: 0.04). Community PC referrals also rose
significantly (13% to 39%, p: 0.01).
PDSA Cycle 2 failed to improve measures compared to baseline. Only
42% of eligible patients were discussed in the MDM. Most agreed plans
were implemented, but only a minority included SPC review, community
PC referral, or advanced care planning.
Conclusion: Patients with ESLD continued to have unmet PC needs
despite implementing an intervention based on expert guidance. PDSA
Cycle 1 demonstrated some significant, positive impacts, supporting the clinical utility of the SPICT, but within the context of a small, single centre QI project with methodological limitations.
Date Acceptance
2025-11-12
Citation
BMJ Open Quality
ISSN
2399-6641
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open Quality
Copyright Statement
Copyright © 2025 Copyright Owner. This is the author’s accepted manuscript made available under a CC-BY licence in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy)
License URL
Publication Status
Accepted
Date Publish Online
2025-11-28