{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T23:02:00Z","timestamp":1767826920453,"version":"3.49.0"},"reference-count":15,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2016,9,26]],"date-time":"2016-09-26T00:00:00Z","timestamp":1474848000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006662","name":"National Institute on Handicapped Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006662","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006662","name":"National Institute on Handicapped Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006662","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006662","name":"National Institute on Handicapped Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006662","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004328","name":"Genentech","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004328","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Since 1970, there has been a 400% increase in liver\u2010related deaths due to the increasing prevalence of chronic liver disease in the United Kingdom (UK). The 2013 <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content> National Confidential Enquiry into Patient Outcome and Death report found that only 47% of patients who died from alcohol\u2010related liver disease received \u2018good care\u2019 during their hospital stay.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To develop a \u2018care bundle\u2019 for patients with decompensated cirrhosis, aiming to ensure that evidence\u2010based treatments are delivered within the first 24 h of hospital admission.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This work gives practical advice about how to implement the bundle and examines its effects on patient care at three National Health Service Hospital Trusts in the <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content> by collecting data on patient care before and after introduction of the bundle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data were collected on 228 patients across three centres (59% male, median age 53 years). Alcohol\u2010related liver disease was the aetiology of chronic liver disease in 85% of patients. The overall mortality rate during hospital admission was 15%. The audits demonstrated improvements in patient care for patients with a completed care bundle who were significantly more likely to have a diagnostic ascitic performed within the first 24 h (<jats:italic>P<\/jats:italic> = 0.020), have an accurate alcohol history documented (<jats:italic>P<\/jats:italic> &lt; 0.0001) and be given antibiotics as prophylaxis against infection following a variceal haemorrhage (<jats:italic>P<\/jats:italic> = 0.0096). In Newcastle, the bundle completion rate increased from 25% to 90% during the review periods.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The introduction of a care bundle was associated with increased rates of diagnostic paracentesis and antibiotic prophylaxis with variceal haemorrhage in patients with decompensated cirrhosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.13806","type":"journal-article","created":{"date-parts":[[2016,9,26]],"date-time":"2016-09-26T10:06:46Z","timestamp":1474884406000},"page":"1030-1038","source":"Crossref","is-referenced-by-count":36,"title":["Implementation of a \u2018care bundle\u2019 improves the management of patients admitted to hospital with decompensated cirrhosis"],"prefix":"10.1111","volume":"44","author":[{"given":"J. K.","family":"Dyson","sequence":"first","affiliation":[{"name":"Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Rajasekhar","sequence":"additional","affiliation":[{"name":"City Hospitals Sunderland Sunderland UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Wetten","sequence":"additional","affiliation":[{"name":"City Hospitals Sunderland Sunderland UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. H.","family":"Hamad","sequence":"additional","affiliation":[{"name":"Royal Cornwall Hospital NHS Trust Cornwall UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Ng","sequence":"additional","affiliation":[{"name":"Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Paremal","sequence":"additional","affiliation":[{"name":"Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. F.","family":"Baqai","sequence":"additional","affiliation":[{"name":"Royal Cornwall Hospital NHS Trust Cornwall UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. A.","family":"Lamb","sequence":"additional","affiliation":[{"name":"Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Masson","sequence":"additional","affiliation":[{"name":"Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Hudson","sequence":"additional","affiliation":[{"name":"Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Dipper","sequence":"additional","affiliation":[{"name":"Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Cowlam","sequence":"additional","affiliation":[{"name":"City Hospitals Sunderland Sunderland UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Hussaini","sequence":"additional","affiliation":[{"name":"Royal Cornwall Hospital NHS Trust Cornwall UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"McPherson","sequence":"additional","affiliation":[{"name":"Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,9,26]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agn020"},{"key":"e_1_2_7_3_1","unstructured":"NHS Atlas of Variation for People with Liver Disease: Reducing Unwanted Variation to Increase Value and Improve Quality. Right Care 2013. Availabe at:http:\/\/www.rightcare.nhs.uk\/index.php\/atlas\/liver-disease-nhs-atlas-of-variation-in-healthcare-for-people-with-liver-disease\/(accessed 1 July 2016)."},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61838-9"},{"key":"e_1_2_7_5_1","unstructured":"The All\u2010Party Parliamentary Hepatology Group (APPHG) Inquiry into Improving Outcomes in Liver Disease. Liver disease: today's complacency tomorrow's catastrophe 2014. Available at:http:\/\/www.hcvaction.org.uk\/resource\/liver-disease-todays-complacency-tomorrows-catastrophe-all-party-parliamentary-hepatology(accessed 1 July 2016)."},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60355-4"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i124"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2012.04.004"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.02.042"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23500"},{"key":"e_1_2_7_11_1","unstructured":"\u201cMeasuring the Units\u201d \u2010 A review of patients who died with alcohol related liver disease. In: National Confidential Enquiry into Patient Outcome and Death (UK) 2013. 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