Liver Services at Imperial College Healthcare NHS Trust
The liver services at Imperial College Healthcare NHS Trust, led by Dr. Ameet Dhar, provide a comprehensive range of services for patients with liver conditions. With over 2000 new patients seen annually, services include inpatient care, specialist clinics, outreach programs, and referral pathways. The team of experienced consultants offers specialized care for various liver issues such as cirrhosis, NAFLD, alcohol liver disease, viral infections, transplantation, and more, ensuring high-quality treatment and management for patients.
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Liver services at ICHNT Dr Ameet Dhar PhD FRCP Consultant Hepatologist and Head of Speciality for Liver Imperial College Healthcare NHS Trust
Liver Services: Current Service Structure of current service Services available Referral pathways
Liver Services: Current Service Lead provider for liver services in NWL. See over 2000 new patients per year and > 10,000 follow appointments Over 1000 patients admitted under our care per year.
Liver Services: Current Service 3 academic consultants providing 0.7 WTE clinical activity. Provide liver services across 4 sites within the trust 4 full-time clinical consultants with 3 less than full-time clinical consultants SITE Inpatient care General Hepatology clinics / week Specialist clinics Ambulatory care unit 10th Floor QEQM: - Paracentesis - Liver Biopsy - Venesection - Clinical Trials - Fibroscan Lists ST MARYS (main site) Douglas Ward 10 per week (all include access to real time fibroscan) - Cirrhosis (x4 per wk) - NAFLD (x2 per wk) - Alcohol (x1 per wk) - HCV and HBV (x3 per wk) - Transplant (x1 per wk) - Acute liver injury (x1 ) - PBC & Autoimmune (x1) - Viral Family & Pregnancy HAMMERSMITH Outreach 3 per week - Pregnancy (QCH) - HCC (x1 per week) - CHARING CROSS Outreach 2 per week - - ST. CHARLES - 1 per week - -
Summary of referral pathway Consultant to Consultant referrals Ambulatory care (clinical day unit) Referral ERS General Hepatology OPD Clinic GP referral Specialist Liver clinic CCG commissioned Referral guidelines if applicable Real time fibroscan at SMH site in OPD
Liver Services: Speciality Services - Cirrhosis clinics (x4 per wk) : Dr Dhar (Lead), Dr Manousou, Dr Lewis, Dr Selvapatt - NAFLD clinics (x2 per wk): Dr Manousou (Lead), Dr Yee (Endocrine and Diabetes) - Alcohol Liver disease (x2 per wk): Dr Lewis (Lead), Dr Vergis, James Lovendoski - HCV and HBV (x3 per wk): Professor Brown (Lead), Dr Smith, Dr Lemione - Transplant (x1 per wk): Dr Dhar (Lead) - Acute liver injury (x1 per wk ): Dr Possamai, Dr Dhar - PBC & Autoimmune (x1 per wk): Dr Smith - Pregnancy and Liver Disease (non- viral) (once per month): Dr Smith - Viral Family & Pregnancy (twice per month): Professor Brown - HCC clinic (x1 per wk) : Professor Khan
Cirrhosis clinic: Current Service 2008: cirrhosis clinic October 2013: 2017: current status Pre-cirrhosis clinic Pre-OLT clinic No dedicated service Clinic Clinic (AD) Clinic & Vasc disorder (AD) Cirrhosis MDT Pre OLT (AD) Pre OLT (AD) Alc cirrhosis service (BC) Clinic (PM) Nurse led education (HM) Clinic (NS) HPS/PPS MDT with Pulm HT HH Clinic (HL): Palliation
Cirrhosis clinic: Current Service vascular disorders of the liver. Referrals decompensated CLD / variant syndrome patients / HPS& PPS patients Referrals from ward or general Hepatology/ Gastroenterology OP Referrals from other specialities (oncology / HIV / haematology) No direct GP referrals at present Cirrhosis clinics acts as a feeder to Pre OLT clinic.
Cirrhosis clinic: Outcome mortality rates 60 50 40 predicted 1 year mortality 30 Actual 1 year mortality 20 10 0 Childs A Childs B Childs C
Value of Ambulatory Care: Cost-benefit analysis of LVP on the 10th Floor 46 procedures 2016 via 10th floor clinical unit. Admission via Accident & Emergency with overnight stay in acute medical bed for LVP 2847.00 Daycase admission to 10th Floor liver unit with LVP 474.00 Complications: 1 (admitted) 1 post-procedural bleed Cost-saving per case 2373.00 Admissions from day-unit: 3 Post procedural Bleed Hepatic hydrothorax SBP Amount saved in 2016 109158.00 (46 x 2373) Missed cases across the trust in 2016 (n = 6) 10 bed days Missed cost savings in 2016 28470.00 Potential for further cost savings (extra 19 cases/yr) 65 per year capacity 45087.00 Mukherjee & Dhar 2017
NAFLD: Current Service Dedicated NAFLD clinic twice weekly (Dr Manousou and Dr Yee) Referrals from general Hepatology/ Gastroenterology OP/ Endocrine / Obesity Service No direct GP referrals at present Joint clinic with Endrocrine/ Diabetes, with access to dietician. Pathway with obesity services
ALD: Current Service Dedicated ALD liver clinic once per week (Dr Lewis and Dr Vergis) Dedicated alcohol and addiction specialist nurse Access to real time fibroscan Outpatient detoxifcation regimen in ALD patients
Fibroscan Service 350 One of the largest providers in the UK (>3000 fibroscans per year) Real time in clinic and dedicated elective lists (nurse led) Access to CAP and LSM with XL probes for raised BMI patients 300 250 200 150 100 50 0 Sept Dec July Nov April Mar-19 Aug Jan-19 May Oct Feb-19 June Scheduled Real Time Real time fibroscan pathway: Avoids unnecessary follow ups Patients - fewer days lost at work Benefits for CCGs - reduces appointment costs, release of appointments to see more appropriate patients Implementing real time fibroscan service, identified cost savings to commissioners. Process completed in 1 day Hepatology New Appointment Intervention / Discharge to GP Real Time Fibroscan
Other services / useful contacts GP email helpline: hepatologyadvice.imperial@nhs.net Secretary: 02033126254 (Maureen Allen lead secretary) Hepatology Registrar Bleep 1316 via Switchboard (9am-5pm) GI bleed Registrar covering St. Marys via Switchboard (5pm-9am).
