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PTU-085 Virtual clinics offer an effective and safe addition to standard out-patient hepatology services

Introduction Many patients with abnormal liver function tests/steatosis do not have serious liver disease, and risk assessment for advanced disease can often be performed without face to face out-patient (OPC) review using laboratory results and other data. Virtual clinics (VC) may offer a useful adjunct to OPC increasing capacity for those requiring specialist care, and reduced patient visits. We piloted a consultant-led VC and assessed impact on OPC use. Methods A retrospective audit was undertaken examining records of patients referred to liver VC/OPC (excluding viral hepatitis) in the year July 201–8. Clinical/demographic data were collected including referral detail, investigation results, and outcome of review. Appropriateness of referral route was reviewed by a consultant taking into account need for, and number of, OPC visits. Results VC 84 patients had initial review in VC. 72 (85.7%) were community referrals, and 12 (14.3%) from other specialties. There were no documented safety issues in patients managed in VC. 50 (59.5%) were discharged after VC review, including 45 (62.5%) of community referrals, equivalent to 4.2 unused OPC per month. Most were people with abnormal liver biochemistry or steatosis but low risk Fib4 score. Of 34 (40.5%) who required subsequent OPC assessment 3 did not attend, 12 (14.3%) required just 1 visit before discharge, 13 (15.5%) needed – OPC, and 6 (7.1%) entered long term follow up. In total 64.7% (22/34) of OPC need was solely for fibrosis assessment by Fibroscan, with 9/22 (40.9%) discharged with normal result. OPC OPC referrals were reviewed (n=703), to determine how many would have been suitable for initial VC assessment. 456 first OPC attendances were identified after excluding cancellations/non-attenders. 40 (8.7%) were discharged immediately, and 86 (18.5%) were awaiting results to guide follow-up decision. These groups were considered potentially appropriate for VC, and reviewed in detail. Those placed on follow-up pathways were unlikely to be suitable and were not analysed further. Of those discharged at visit 1, 30 (75%) would have been suitable for first review in VC, with 25 of those not requiring OPC attendance at all. Of 86 awaiting results, 58 (67.4%) were suitable for first review in VC with 27 requiring no OPC input. A further 15 (17.4%) could have avoided at least 1 visit. Taken together, this equates to 88/456 (19.3%) visits which could have been conducted by VC, of whom 52/456 (11.4%) required no OPC input at all. Including the 15 potentially avoidable visits, a total 67 OPC (5.6/month) could be saved (9.5% of all OPC referrals). Conclusions Most VC patients can be safely discharged without need for OPC, and expansion could further increase capacity for those requiring face-to-face specialist care. All our new referals are now initially vetted by VC.