P31 An audit of a referral pathway from primary care to a nurse-led non-alcoholic fatty liver disease clinic

NAFLD is prevalent in 25% of the UK adult population, however only a minority of patients develop advanced fibrosis or cirrhosis. In 2014, we established a referral pathway from primary care based on risk stratification using non-invasive tests in order to rationalise referrals.1 The pathway consisted of a FIB-4 as the first step, followed by an ELF score if the FIB-4 was above 1.3. Patients with an ELF>9.8 and raised FIB-4 were referred to secondary care. In 2020 we established a nurse-led clinic and we present the results of a 1-year audit of the cohort.Data was collected from an electronic notes system including the referral documentation from primary care. Fib4 scores were taken from referral documentation and where not available was calculated on bloods taken at clinic. ELF was recorded when available from primary care. Fibroscan scores were recorded with >8.0kPA indicating suspected significant fibrosis and >12.0kPA indicating suspected advanced fibrosis. Additionally, referral outcome data was collected.100 new patients were seen over 16 months. Main characteristics were: mean age 60 years, 51% females, mean BMI 32 kg/m2, 37% diabetes, 65% dyslipidaemia, 56% hypertension. The vast majority of patients (92%) were referred from primary care and just 8% from other specialties. 28 patients had a Fib4 documented on referral, of which 3 were low risk for fibrosis (8kPA and 15 patients >12kPA. 92 patients had an US liver of which six were suggestive of cirrhosis and three were inconclusive. Of the 6 patients with suggestive fibrosis, only 3 had a raised Fib4. 7 patients were referred for a biopsy. 51 patients were discharged back to GP following a single clinic appointment.This study highlights that less than half of patients have been referred to the NAFLD pathway appropriately. These patients are at significant risk of disease progression and morbidity. Greater efforts must be made to collaborate with primary care and referring teams to ensure sufficient education regarding the pathway to ensure the correct patients are seen in the secondary care clinic.Srivastava A, et al. ‘Prospective evaluation of a primary care referral pathway for patients with