189 Non-malignant liver disease: a retrospective audit of hospital inpatient deaths

Background Liver disease has a fluctuating course and palliative care involvement is often only when death is imminent: we are missing opportunities for symptom control and advance care planning. The Supportive and Palliative Care Indicators Tool (SPICT) aids healthcare professionals in identifying patients who would benefit from holistic assessment and care planning. We aimed to examine deaths from non-malignant liver disease in Birmingham Heartlands Hospital (BHH) using the SPICT to ascertain palliative care involvement, joint working and prognostication of these patients. Methods Over a retrospective 12-month period, the notes and online records of all patients who died on the gastroenterology ward of non-malignant liver disease at BHH were collected and reviewed in respect to their last admission. Their SPICT scores were subsequently calculated (general and liver-specific). Results 34 patients met the study criteria. One patient was potentially fit for transplant. Every patient in the cohort had met at least one of the symptom burden criteria with 67% documented as having a troublesome symptom burden. The most predominant liver related symptom was ascites. 9 of the cohort were referred to the hospital palliative care team. The corrected mean time from referral to death was 4.3 days, with 3 of the patients dying the day of referral. Conclusion This study showed that despite having a high symptom burden, very few of this cohort were referred to palliative care in sufficient time to adequately manage symptoms, if at all. Introducing the SPICT to this setting could act as a means of prompting referrals to palliative care. We also suggest that future research needs to address how gastroenterologists recognise deterioration and dying in their patient population, and whether there are further barriers to referring to palliative care in the hospital setting.