BMJ Open Gastroenterology (Dec 2023)
Quality standards for the management of alcohol-related liver disease: consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology ARLD special interest group
- Paul Richardson,
- Steven Masson,
- Ashwin Dhanda,
- Ewan Forrest,
- Ankur Srivastava,
- Pauline Dundas,
- Lynsey Corless,
- Jennifer Towey,
- Neil Rajoriya,
- Christopher Oldroyd,
- Sarah Morgan,
- James Maurice,
- Richard Aspinall,
- Joanne McDonagh,
- Sara Bardell,
- Richard Parker,
- Vanessa Hebditch,
- Michael Allison,
- Ryan Buchanan,
- Robert Goldin,
- Steve Hood,
- Joanne Sayer,
- Vikram Bains,
- J Ryan,
- Thomas Phillips,
- Seonaid Anderson,
- Ian Davidson,
- Ian Webzell,
- Victoria Lavers,
- Nicole Rainford,
- Arron Jones,
- Emma Stennett,
- Jeff Fernandez,
- Erica Forster,
- Dennis Freshwater,
- Ruth Gailer,
- Deborah Lindsay,
- Tania Nurun,
- Elizabeth Oxley,
- Sally Pannifex,
- Graham Parsons,
- Mandy Smith,
- Roya Vaziri,
- Andrew Wellstead
Affiliations
- Paul Richardson
- Gastroenterology and Hepatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
- Steven Masson
- Liver unit, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Ashwin Dhanda
- Faculty of health, University of Plymouth, Plymouth, UK
- Ewan Forrest
- Dept of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
- Ankur Srivastava
- Gastroenterology and hepatology, North Bristol NHS Trust, Westbury on Trym, UK
- Pauline Dundas
- Peter Brunt Centre, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
- Lynsey Corless
- Department of Gastroenterology, Hepatology and Endoscopy, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Jennifer Towey
- Birmingham Liver Services Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Neil Rajoriya
- Birmingham Liver Services Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Christopher Oldroyd
- Cambridge Liver Unit, Addenbrooke`s Hospital, Cambridge, UK
- Sarah Morgan
- Hampstead Group Practice, London, UK
- James Maurice
- Gastroenterology and hepatology, North Bristol NHS Trust, Westbury on Trym, UK
- Richard Aspinall
- Gastroenterology & Hepatology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
- Joanne McDonagh
- Birmingham Liver Services Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Sara Bardell
- Birmingham Liver Services Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Richard Parker
- Leeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Vanessa Hebditch
- British Liver Trust, Ringwood, UK
- Michael Allison
- Cambridge Liver Unit, Addenbrooke`s Hospital, Cambridge, UK
- Ryan Buchanan
- Faculty of Medicine, University of Southampton, Southampton, UK
- Robert Goldin
- Department of Digestive Diseases, Department of Medicine, Imperial College London, London, UK
- Steve Hood
- Digestive Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Joanne Sayer
- Gastroenterology, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, UK
- Vikram Bains
- Liver Transplant Unit, King`s College Hospital NHS Foundation Trust, London, UK
- J Ryan
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, London, UK
- Thomas Phillips
- Faculty of Health Sciences, University of Hull, Hull, UK
- Seonaid Anderson
- Angus Integrated Drug and Alcohol Recovery Service (AIDARS), Ninewells Hospital and Medical School, Dundee, UK
- Ian Davidson
- NHS Fife Addiction Services, NHS Fife, Kirkcaldy, UK
- Ian Webzell
- Liver Transplant Unit, King`s College Hospital NHS Foundation Trust, London, UK
- Victoria Lavers
- Independent researcher, Plymouth, UK
- Nicole Rainford
- Liver Transplant Unit, King`s College Hospital NHS Foundation Trust, London, UK
- Arron Jones
- Pharmacy, Barts and The London NHS Trust, London, UK
- Emma Stennett
- Gastroenterology, Guy`s and St Thomas` Hospitals NHS Trust, London, UK
- Jeff Fernandez
- Alcohol and Drug Liaison, Royal Free London NHS Foundation Trust, London, UK
- Erica Forster
- Leeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Dennis Freshwater
- Birmingham Liver Services Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Ruth Gailer
- Islington Primary Care Federation, London, UK
- Deborah Lindsay
- Alcohol Care Team, East Lancashire Hospitals NHS Trust, Blackburn, UK
- Tania Nurun
- Department of Gastroenterology, Hepatology and Endoscopy, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Elizabeth Oxley
- St Martins Practice, Leeds, UK
- Sally Pannifex
- Hepatology, St George`s Healthcare NHS Trust, London, UK
- Graham Parsons
- Hepatology, Plymouth Hospitals NHS Trust, Plymouth, UK
- Mandy Smith
- Alcohol care team, Southport and Ormskirk Hospital NHS Trust, Southport, UK
- Roya Vaziri
- Humankind, Durham, UK
- Andrew Wellstead
- Gastroenterology, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- DOI
- https://doi.org/10.1136/bmjgast-2023-001221
- Journal volume & issue
-
Vol. 10,
no. 1
Abstract
Objective Alcohol-related liver disease (ALD) is the most common cause of liver-related ill health and liver-related deaths in the UK, and deaths from ALD have doubled in the last decade. The management of ALD requires treatment of both liver disease and alcohol use; this necessitates effective and constructive multidisciplinary working. To support this, we have developed quality standard recommendations for the management of ALD, based on evidence and consensus expert opinion, with the aim of improving patient care.Design A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology ALD Special Interest Group developed the quality standards, with input from the British Liver Trust and patient representatives.Results The standards cover three broad themes: the recognition and diagnosis of people with ALD in primary care and the liver outpatient clinic; the management of acutely decompensated ALD including acute alcohol-related hepatitis and the posthospital care of people with advanced liver disease due to ALD. Draft quality standards were initially developed by smaller working groups and then an anonymous modified Delphi voting process was conducted by the entire group to assess the level of agreement with each statement. Statements were included when agreement was 85% or greater. Twenty-four quality standards were produced from this process which support best practice. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice and an audit tool provided.Conclusion It is hoped that services will review their practice against these recommendations and key performance indicators and institute service development where needed to improve the care of patients with ALD.
