P117 A call for inclusion in addressing variation in UK hospital liver care; a review of national audits, surveys, guidelines and guidance documents from the last five years

<h3>Introduction</h3> The morbidity and mortality from liver disease has continued to rise over the past half a century. This contrasts with other common illnesses. Alongside this, regional variations in care and outcomes have repeatedly been highlighted for patients with liver disease across the UK. Numerous strategies have been proposed to address this issue, but this remains a major healthcare inequity. In this study, we analysed data from national audits/surveys and guidelines/guidance documents to understand common themes, contributorship and propose potential solutions to reduce variation in care. <h3>Methods</h3> We included all audits/surveys and guidelines/guidance documents endorsed by UK societies over the past 5 years. Specialist and non-specialist liver services were compared for contributions, as were regions. Authorship of guideline/guidance documents was also analysed for proportion of female, non-Gastroenterology/Hepatology and Allied Health Professional/Pharmacist/Liver Nurse authorship. Common themes were identified across audits/surveys. <h3>Results</h3> Six audit/surveys and twelve separate guidelines/guidance workstreams were identified. Non-specialist liver services were less well represented across audits/surveys (98% v 68%, p&lt;0.001*) although trainee-led audits had greater participation from non-specialist liver services. Common themes from audits/surveys included a global lack of compliance with national standards, better performance/outcomes at specialist liver services, regional variation in outcomes, limited number of patients transferring from non-specialist to specialist liver services, and staffing and social deprivation impacting on patient outcomes (figure 1). Across guidelines/guidance documents, there was variation in the proportion of female, Allied Health Professional/Nursing/Pharmacy and patient representative authorship. Most authors were from specialist liver services (155/166). London (46/166) and Birmingham (28/166) were well represented in authorship with Northern Ireland (0/166) and Wales (2/166) being significantly less well represented. <h3>Conclusion</h3> To reduce variation in care, it is vital that an inclusive approach is undertaken across the UK. This includes ensuring all regions and non-specialist liver services are included in guideline/guidance document development and are supported in workforce development. Clinical networks are required to ensure all patients have equitable access to specialist care/interventions provided as locally as feasible.