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Implementation of a care bundle improves the management of patients with non-alcoholic fatty liver disease

Lookup NU author(s): Dr Laura Neilson, Dr Louise MacDougall, Dr Timothy Hardy, Dr David Beaton, Dr April Phaw, Laura Haigh, Dr Kate HallsworthORCiD, Dr Diana Mansour, Dr Jess Dyson, Dr Steven MassonORCiD, Professor Quentin AnsteeORCiD, Professor Stuart McPhersonORCiD



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


© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Background: Non-alcoholic fatty liver disease (NAFLD) is common and is associated with liver-related and cardiovascular-related morbidity. Our aims were: (1) to review the current management of patients with NAFLD attending hospital clinics in North East England (NEE) and assess the variability in care; (2) develop a NAFLD 'care bundle' to standardise care; (3) to assess the impact of implementation of the NAFLD care bundle. Methods: A retrospective review was conducted to determine baseline management of patients with NAFLD attending seven hospitals in NEE. A care bundle for the management of NAFLD was developed including important recommendations from international guidelines. Impact of implementation of the bundle was evaluated prospectively in a single centre. Results: Baseline management was assessed in 147 patients attending gastroenterology, hepatology and a specialist NAFLD clinic. Overall, there was significant variability in the lifestyle advice given and management of metabolic risk factors, with patients attending an NAFLD clinic significantly more likely to achieve >10% body weight loss and have metabolic risk factors addressed. Following introduction of the NAFLD bundle 50 patients were evaluated. Use of the bundle was associated with significantly better documentation and implementation of most aspects of patient management including management of metabolic risk factors, documented lifestyle advice and provision of NAFLD-specific patient advice booklets. Conclusion: The introduction of an outpatient 'care bundle' led to significant improvements in the assessment and management of patients with NAFLD in the NEE and could help improve and standardise care if used more widely.

Publication metadata

Author(s): Neilson LJ, MacDougall L, Lee PS, Hardy T, Beaton D, Chandrapalan S, Ebraheem A, Hussien M, Galbraith S, Looi S, Oxenburgh S, Phaw NA, Taylor W, Haigh L, Hallsworth K, Mansour D, Dyson JK, Masson S, Anstee Q, McPherson S

Publication type: Article

Publication status: Published

Journal: Frontline Gastroenterology

Year: 2021

Volume: 12

Issue: 7

Pages: 578-585

Print publication date: 01/12/2021

Online publication date: 04/01/2021

Acceptance date: 08/10/2020

Date deposited: 19/03/2021

ISSN (print): 2041-4137

ISSN (electronic): 2041-4145

Publisher: BMJ Publishing Group


DOI: 10.1136/flgastro-2020-101480


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