Multidisciplinary One-Stop Diagnostic Liver Clinic Delivers 46% Discharge Rate at First Appointment
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Authors
Kerry G.
Brindley J.H.
Lim T.Y.
Cox L.
Muchelemba E.
Sharma V.
Alazawi, W.
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2025
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Article
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Background Referrals to hepatology clinics are increasing, leading to long waiting times for patients. Most clinical encounters begin with a set of aetiological tests, the results of which are reviewed at follow up often many months after the initial consultation. The Barts Health One-Stop Diagnostic Liver Clinic was established to ensure that tests are completed prior to first attendance and to perform transient elastography in conjunction with clinical review. We sought to determine the proportion of patients referred to this service who were discharged at first visit, reducing the pressure on the current outpatient capacity. Methods Referrals were triaged by a clinical nurse specialist (CNS) who requested a non-invasive liver screen two weeks before clinic. Cross-sectional liver imaging was requested at point of referral acceptance for those with liver lesions. At the clinic visit, patients underwent transient elastography and saw a physician, CNS or dietician. Demographic, clinical and patient disposition data were extracted from electronic record systems for patients seen in one-stop clinic from May 2023- August 2024 and analysed in Microsoft Excel. Results Over the 15-month period there were 774 total referrals to all outpatient hepatology of whom 217 patients were triaged to the one-stop clinic. The majority (132/217, 61.3%) were referred with abnormal liver function tests. 34.6% (75/ 217) were referred with abnormal imaging and 28% (21/75) of these had a liver lesion seen on imaging. The most common diagnosis was MASLD, metabolic-dysfunction associated steatotic liver disease, (72.8%, 158/217). 100 patients (46.1%) were discharged on the day of the one-stop clinic and a further 12.9% (28/217) discharged after virtual or telephone follow up. 35% (76/217) were referred from one-stop to hepatology clinic directly and 6% (13/217) were referred into hepatology services after virtual or telephone follow-up. Of patients referred with a liver lesion 95.2% (20/21) were discharged back to their GP from onestop clinic. Conclusions The one-stop service has streamlined the clinical encounter offering specialised clinical diagnosis and advice contemporaneous with test results. Reducing follow up generates outpatient capacity for other patients. The benefits of this model - including the effectiveness of the specialist clinical input - compared to liver testing prior to referral warrant further investigation.
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