Liver Surveillance

Background

Trusts often find the management of hepatocellular carcinoma (HCC) cirrhotic liver surveillance patients to be a challenge. These patients require regular surveillance over a long period, and it can be difficult to manage the logistics of where a patient is within their surveillance cycle.

To solve this issue, many Trusts default to using locally held spreadsheets to manage these patients, but this is risky and can easily lead to missed cycles due to human error. There have been examples of patients with cirrhosis with a treatable lesion on imaging been ‘missed’ by the system and later present with a decompensated disease (liver failure) due to untreatable / advanced HCC. NECS have developed a tool to improve clinical safety and governance by removing this risk.

Application Development

St Helens and Knowsley Teaching Hospitals NHS Trust (STHK) identified a requirement to replace their current system of spreadsheets with a web-based solution.

The Trust worked with NECS to develop an application which provides effective patient management of the Trust’s HCC liver surveillance programme to ensure effective call / recall of patients and tracking of clinical decisions.

NECS worked with Mark Fox, Consultant Gastroenterologist at STHK, to develop the application and delivered a minimum viable product (MVP) in August 2020.

Overview of the System

STHK run a HCC Liver Surveillance Programme which monitors patients every six months with annual follow up in clinics. The fundamental purpose of the app is to manage this cyclical review process.

After adding patient demographic data, users can select initial test results from a drop-down list of possible tests. Test results are then inputted into the system, and it calculates the following:

  • Child-Pugh score (A/B/C).
  • UKELD score – calculated from several parameters based on blood results which are manually entered.

Users can add further test cycles following a patient review and consultation at regular intervals.

The system automatically generates letters and emails to be sent to patients for appointments through a series of customisable templates.

Depending on patient diagnostics, further test cycles can be scheduled, allowing the clinician to choose from a selection of different test types.

Improved Reporting

The system produces several operational and governance reports. Critically, this means there is clarity around the next steps and transparency around performance.

Reports available include:

  • Weekly service reports showcasing tests due, tests for review, abnormal tests requiring action.
  • Periodic governance reports to assess service performance against sub-speciality key performance indicators (KPIs).
  • Periodic activity and outcome reports: number in surveillance, DNA rates, HCC rates and mortality rates.