COVID-19: Hepatology service guide

April 2020

Scope

This information provides guidance on the management of Hepatology patients across Eastern & Northern localities during the Covid-19 pandemic. The information is based on national guidance and local recommendations.

National guidance

British Society of Gastroenterology: COVID-19 Guidance & Advice

British Society of Gastroenterology/British Association for the Study of the Liver COVID-19 Advice on Heptalogy patient risk groups

2WW referrals

e-Referral Service Selection:

  • Specialty: 2WW
  • Clinic type: 2WW Upper GI
  • Service: 2WW Upper GI (Medicine Only) - NDHCT - NDDH - RBZ/ Two Week Wait Colorectal Surgery / Lower GI- RAS-RDE-RH8

Acute Jaundice requires urgent referral as usual

Conditions with specific guidance

Patients with liver disease in high risk group*:

`Shielded group` Advise mandatory self – isolation:

  1. All recipients of liver transplantation taking immunosuppression
  2. Patients with autoimmune hepatitis taking immunosuppression

The consensus view in our specialty acknowledges the higher risk for patients with decompensated cirrhosis, who are not included in the shielding cohort. We recommend that these patients with decompensated cirrhosis should be advised to adhere strictly to social distancing measures in order to protect themselves.

Liver Transplantation

British Transplantation Soceity: COVID-19 Information

Urgent referrals

All patients with decompensated cirrhosis: ascites, hepatic encephalopathy, worsening jaundice, and suspected liver cancer require urgent Hepatology referral as usual.

Routine referrals

All new routine referrals will be clinically triaged and will either be added to a waiting list or, if appropriate, A&G will be given.

Please ensure that a practice-based system is in place to check daily for returning referrals with A&G.

Royal Devon & Exeter NHS Foundation Trust: Use advice and guidance pathway for management of abnormal liver blood tests in primary care.

Northern Devon Healthcare NHS Trust: Refer through the usual DRSS e-RS referral pathway for advice on management of abnormal liver blood tests in primary care via Pre-choice Triage.

Prior to making a routine referral, please ensure that any appropriate Policy or CRG has been reviewed and that all the suggested investigations and management options have been considered.

Management of Abnormal Liver Function Tests in Asymptomatic Adults

Existing new and follow-up routine appointments have been cancelled and changed to telephone / video consultation where appropriate

Urgent advice

For urgent advice, contact the Gastroenterology consultant on call via switchboard:

  • Royal Devon & Exeter NHS Foundation Trust telephone: 01392 411611
  • Northern Devon Healthcare NHS Trust telephone: 01271 322577

Advice & Guidance

Royal Devon & Exeter NHS Foundation Trust: We provide electronic Advice & Guidance service – manned by the Gastroenterology Consultant on-call of the week

Northern Devon Healthcare NHS Trust: We provide Pre-Choice Triage via e-RS through the usual DRSS referral pathway

COVID-19 high risk patient advice

See our Patient Advice on the following links:
Patients with liver disease in high risk group:

`Shielded group` Advise mandatory self – isolation:

  1. All recipients of liver transplantation taking immunosuppression
  2. Patients with autoimmune hepatitis taking immunosuppression
  3. Patients with decompensated liver cirrhosis

Pathway Group

This guideline has been signed off by Eastern & Northern locality on behalf of the NHS Devon Clinical Commissioning Group

Last updated: 04-05-2020

 

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