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Do primary care physicians appropriately act on radiological confirmation of fatty liver?
EP34330
Poster Title: Do primary care physicians appropriately act on radiological confirmation of fatty liver?
Submitted on 29 Oct 2020
Author(s): Aqeel Butt, Mohan Seevaratnam
Affiliations: London North West University Healthcare NHS Trust, St. Peter's Medical Centre
This poster was presented at BIR Annual Congress 2020
Poster Views: 310
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Poster Information
Abstract: Aims: 1. Analyse whether primary care physicians are correctly utilising ultrasounds confirming fatty liver and appropriately implementing the NAFLD Fibrosis Score as per EASL guidance 2. Assess if patients are being appropriately followed up after radiological confirmation of fatty liver and non-invasive scoring.

Methods: Ultrasound reports received by the GP practice confirming fatty liver between 1st July 2019 and 31st December 2019 were obtained. In each case, it was determined whether the NAFLD Fibrosis Score was calculated and whether subsequent management was appropriate.

Results: 27 ultrasound reports were received which demonstrated fatty liver. 5 (18.5%) patients had a NAFLD Fibrosis Score calculated and 3 (60%) of these had scoring calculated incorrectly, leading to 1 (33.3%) patient being inappropriately referred to secondary care. Of the 5 scored patients, 3 (60%) had a documented follow-up plan and of these 1 (33.3%) had incorrect follow-up planned based upon scoring. Of the 27 patients, 7 (25.9%) had follow-up plans documented with 3 (42.9%) being based upon scoring, 2 (66.7%) of which were scored incorrectly.

Conclusions: This audit suggests that, in general practice, a poor job is being done of suitably acting upon radiological confirmation of fatty liver. NAFLD Fibrosis scoring is not being implemented correctly, resulting in inappropriate follow-up and management. As such, we provided a teaching session for staff who would be managing future fatty liver patients. We aim to implement an electronic alert notifying clinicians to complete NAFLD Fibrosis scoring whenever fatty liver is coded and aim to re-audit in due course.
Summary: This audit was conducted at a GP practice over a 6 month period to ascertain whether GPs were acting appropriately upon ultrasound reports confirming fatty liver. it was determined whether they were correctly calculating the NAFLD Fibrosis Score and whether this was being used appropriately to guide patient management.References: 1. National Institute for Health and Care Excellence. Non-alcoholic fatty liver (NAFLD): Definition. Available from: https://cks.nice.org.uk/topics/non-alcoholic-fatty-liver-disease-nafld/background-information/definition/ [Accessed 20th October 2020].

2. National Institute for Health and Care Excellence. Non-alcoholic fatty liver (NAFLD): Complications. Available from: https://cks.nice.org.uk/topics/non-alcoholic-fatty-liver-disease-nafld/background-information/complications/ [Accessed 20th October 2020].

3. National Institute for Health and Care Excellence. Non-alcoholic fatty liver (NAFLD): Risk Factors. Available from: https://cks.nice.org.uk/topics/non-alcoholic-fatty-liver-disease-nafld/background-information/risk-factors/ [Accessed 20th October 2020].

4. National Institute for Health and Care Excellence. Non-alcoholic fatty liver (NAFLD): How should I assess a person with NAFLD?. Available from: https://cks.nice.org.uk/topics/non-alcoholic-fatty-liver-
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