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Response to the NCEPOD report: development of a care bundle for patients admitted with decompensated cirrhosis—the first 24 h

Lookup NU author(s): Professor Stuart McPhersonORCiD, Dr Jess Dyson, Dr Mark Hudson



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Recently, there has been a significant increase in the prevalence of chronic liver disease in the UK, and as a result, hospital admissions and deaths due to liver disease have also increased. The 2013 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) of patients with alcohol-related liver disease (ARLD) found that less than half the number of patients who died from ARLD received ‘good care’, and avoidable deaths were identified. In order to improve the care of patients admitted with ARLD, the NCEPOD report recommended that a ‘toolkit’ for the acute management of patients admitted with decompensated ARLD be developed and made widely available. As a result, we have developed a ‘care bundle’ for patients admitted with decompensated cirrhosis (of all aetiologies) to ensure that effective evidence-based treatments are delivered within the first 24 h. This care bundle provides a checklist to ensure that all appropriate investigations are undertaken when a patient with decompensated cirrhosis presents and provides clinicians with clear guidance on the initial management of alcohol withdrawal, infection, acute kidney injury, gastrointestinal bleeding and encephalopathy. The first 24 h are particularly important, as early intervention can reduce mortality and shorten hospital stay, and specialist gastroenterology/liver advice is not always available during this period. This review will discuss the care bundle and the evidence base behind the treatment recommendations made.

Publication metadata

Author(s): McPherson S, Dyson JK, Austin A, Hudson M

Publication type: Article

Publication status: Published

Journal: Frontline Gastroenterology

Year: 2016

Volume: 7

Issue: 1

Pages: 16-23

Print publication date: 01/01/2016

Online publication date: 02/12/2014

Acceptance date: 28/09/2014

Date deposited: 09/02/2017

ISSN (print): 2041-4137

ISSN (electronic): 2041-4145

Publisher: BMJ Group


DOI: 10.1136/flgastro-2014-100491


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