Higher rates of chronic liver disease have resulted in a significant increase in the number of patients needing regular abdominal paracentesis for ascites. Waiting times for admission at the Royal Wolverhampton NHS Trust had become longer and delays in intervention and treatment became inevitable. In 2014, the Trust developed a nurse-led abdominal paracentesis day-case service. A qualitative evaluation of the service was conducted using in-depth patient interviews and surveys to determine the impact of the service, including how the new nursing role affected the patient experience. The results show that the nurse-led clinical service in gastroenterology positively impacts patients' experiences. Following this innovation, the service was extended to provide intravenous infusions for gastroenterology patients via the day-case unit. With appropriate training and competency assessments, nurses can now perform selected medical procedures safely and effectively, thereby facilitating nursing staff to expand and develop their roles. This development has substantial implications for nursing and is an important contribution to the debate on the future direction of the nursing profession.

The rising incidence of chronic liver disease has resulted in many patients needing recurrent paracentesis for abdominal ascites, which requires hospital admission. A novel nurse-led and delivered day-case paracentesis and intravenous infusion service was developed, and a cost-benefit analysis was undertaken to examine the impact of this service. Data for patients admitted for ascitic paracentesis and intravenous infusions between April and January 2016 were collected, and procedure-related costs and income were calculated. Savings delivered by the service were calculated by determining the cost of bed-days saved by the day-case service. A qualitative analysis of the efficacy of the service was conducted by a patient feedback survey. Over the 10-month period, 559 patients were treated by the day-case service—144 ascitic paracenteses (26%), 87 iron infusions (16%), 307 infliximab infusions (55%) and 21 magnesium infusions (3%). Net income over 10-months was £256 876, with an expenditure of £128 570, yielding a profit of £128 306. Cost-modelling exercises indicated that this would yield an additional cost saving of £153 216 due to inpatient bed-days saved, yielding a total financial benefit of £281 522 (over 10-months). A day-case, nurse-led gastroenterology service provides an innovative, profitable and cost-efficient model of service delivery.

Background: A quality improvement project in a secondary care centre was initiated to investigate and evaluate the impact of staff education and the use of the British Society of Gastroenterology/British Association for the Study of the Liver cirrhosis care bundle in improving care of patients admitted to hospital with decompensated liver cirrhosis. Method: A staff training programme was implemented, involving around 30 health professionals consisting of consultants, junior doctors, physician associates and nurses from the acute medical unit. A review of electronic documentation and analysis of key clinical parameters, pre- and post-intervention, was carried out. Results: The data show that the intervention has led to an improvement in patient management and clinical outcomes. Conclusion: This project illustrates that collaboration between hepatology and medical teams, with emphasis on education and training, benefits patients who present to hospital with decompensated liver cirrhosis.

Endoscopic retrograde cholangiopancreatography (ERCP) facilitates endoscopic access to the common bile duct and pancreatic duct. It has become central to the management of a variety of benign and malignant pancreatobiliary disorders. ERCP remains a technically challenging procedure and patient selection and pre-assessment is critical to ensure good clinical outcomes. Staff assisting in ERCP should familiarise themselves with the underlying principles and basic knowledge pertaining to various aspects of ERCP.

The incidence of liver disease has been steadily increasing, and patients with severe, symptomatic ascites need paracentesis (drainage) of the ascitic fluid for management. The authors and colleagues have previously developed a nurse-led and nurse-managed day-case gastroenterology service that provides paracentesis and other treatments, such as blood transfusion and specialist biologic infusions to patients with inflammatory bowel disease (IBD) and other gastroenterological conditions. This article describes the development of a similar novel nurse-led day-case service within the emergency department (ED) to provide a front-door urgent service for patients attending ED and needing paracentesis/infusions. It also reflects on the journey to developing this service, as well as the challenges faced during to the COVID-19 pandemic.