Impact of a Liver Failure Service for patients with cirrhosis

6-month liver failure program. Liver failure nurses start this service in hospital with some brief education and nutrition assessment. Then a visit to the patient's home 5-7 days after discharge from hospital of 1-1.5 hours duration providing follow-up education and advice. Action plans will be provided to the patient where appropriate - general action plans for cirrhosis as well as very targeted plans regarding the management of ascites and encephalopathy may be given. Medication advice will be provided including indications of all prescribed medications, the importance of compliance, and any side effects that may be experienced. Nutrition advice regarding high protein, low salt diets and the improtance of nutrition in the care of the liver will be covered. After the home visit the patient will receive weekly telephone calls by the liver failure nurses until the patient has been reveiwed in the outpatient clinic by their specialist. At this time the specialist in conjunction with the liver failure nurse and patient will decide on a 'stable' or 'unstable' pathway plan. If unstable, a home visit may again be warranted after outpatient review and/or weekly/fortnightly telphone calls as indicated. Once stable, patients can access the liver failure service for rapid response as suggested on their action plans. Incidents which may trigger rapid response include significant weight gain or loss, distended abdomen, shortness of breath, confusion, diarrhoeah or constipation, medication side effects, difficulty eating/poor diet intake etc.