PTH-156 Impact of BSG and BASL Liver Care Bundle Introduction on Clinical Practice: A University Hospital Experience
Bibliographic record
Abstract
Introduction The National Confidential Enquiry into Patient Outcome and Death for alcohol related liver disease highlighted the need to improve care of patients with decompensated liver disease. BSG and BASL thereafter developed the Liver Care Bundle toolkit to aid provision of evidence-based care within 24 hours of admission. We performed an audit of care delivered to such patients before and after introduction of the Bundle into clinical practice in our hospital. Methods For the initial audit (August 2014-March 2015), patients presenting with decompensated liver disease were retrospectively identified from ward lists, blood bank data for Human Albumin Solution (HAS), and the endoscopy database. Electronic patient records were reviewed against the toolkit. The results were presented at hospital Grand round alongside presentation of the Liver Care Bundle which was, thereafter, implemented throughout the Trust from July 2015. Re-audit using the same methodology was performed September to December 2015. The significance of impact of the Bundle on clinical practice was evaluated using Fisher’s exact test. Results 45 patients were identified for the first part of the audit. The average length of stay was 11 days. Notes for 20 patients with 25 in-patient episodes were reviewed for the re-audit. Average length of stay was 18 days. Conclusion The introduction of the Liver Care Bundle at our institution led to improvement in several aspects of care- especially in the management of variceal haemorrhage. Recognition of patients with excess alcohol consumption and use of Pabrinex was improved upon too. There, however, remain clear areas for improvement. Experiences with the Liver Care Bundle should continue to be widely reported in an attempt to standardise and improve in-patient morbidity and mortality in liver disease. Reference 1 McPherson S, et al. Response to the NCEPOD report: development of a care bundle for patients admitted with decompensated cirrhosis—the first 24 h. Frontline Gastroenterol. 2016 Jan;7(1):16–23. Epub 2014 Dec 2. Disclosure of Interest None Declared
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".