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Development of new clinical pathway for liver ultrasounds is ‘ongoing’

By Niamh Quinlan - 09th Aug 2022


There is still no date for the roll-out of transient elastography for liver disease testing in community settings, according to the HSE National Clinical Programme for Gastroenterology and Hepatology.

The development of the clinical pathway for altered liver functioning tests (LFTs) is a “work in progress”, a spokesperson for the programme told the Medical Independent.

It is over a year since the programme’s hepatology working group was established in May 2021 to commence the design of the LFT pathway. 

The programme is currently securing funding for the project, which will be aligned with Sláintecare principles.

Transient elastography (FibroScan) is a non-invasive test for liver stiffness to determine the degree of fibrosis or scarring that may be present in the liver from various liver diseases or conditions.

The programme spokesperson highlighted that much of the burden placed on hospitals regarding liver disease could be eased through a hub-and-spoke model utilising FibroScan.

“The new hub-and-spoke approach will provide more appropriate nurse and doctor outreach, therefore many outpatients and lower acuity inpatients could be managed in [model] 3 hospitals.” 

Similar to the model employed in the Northern Ireland health service, regional hepatology hubs would be delivered by advanced nurse practitioners (ANPs).

The ANPs would complete diagnosis and staging, FibroScanning, venesection and motivational interviewing for behavioural change.

According to the clinical programme: “A submission to support a national roll-out of a hub-and-spoke model for hepatology was put forward as part of [the] national service plan 2022. This submission included nine [whole-time equivalent] ANPs, which would support the development of regional liver hubs.”

According to Consultant Hepatologist at the Royal Victoria Hospital in Belfast, Dr Conor Braniff, transient elastography has been used by specialist nurses in Northern Ireland to test for viral hepatitis in communities.

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