RT Journal Article SR Electronic T1 Implementation of a care bundle improves the management of patients with non-alcoholic fatty liver disease JF Frontline Gastroenterology JO Frontline Gastroenterol FD BMJ Publishing Group Ltd SP flgastro-2020-101480 DO 10.1136/flgastro-2020-101480 A1 Laura Jane Neilson A1 Louise Macdougall A1 Phey Shen Lee A1 Timothy Hardy A1 David Beaton A1 Subashini Chandrapalan A1 Alaa Ebraheem A1 Mohammed Hussien A1 Sarah Galbraith A1 Shi Looi A1 Sophia Oxenburgh A1 Naw April Phaw A1 William Taylor A1 Laura Haigh A1 Kate Hallsworth A1 Dina Mansour A1 Jessica K Dyson A1 Steven Masson A1 Quentin Anstee A1 Stuart McPherson YR 2021 UL http://fg.bmj.com/content/early/2021/01/03/flgastro-2020-101480.abstract AB Background Non-alcoholic fatty liver disease (NAFLD) is common and is associated with liver-related and cardiovascular-related morbidity. Our aims were: (1) to review the current management of patients with NAFLD attending hospital clinics in North East England (NEE) and assess the variability in care; (2) develop a NAFLD ‘care bundle’ to standardise care; (3) to assess the impact of implementation of the NAFLD care bundle.Methods A retrospective review was conducted to determine baseline management of patients with NAFLD attending seven hospitals in NEE. A care bundle for the management of NAFLD was developed including important recommendations from international guidelines. Impact of implementation of the bundle was evaluated prospectively in a single centre.Results Baseline management was assessed in 147 patients attending gastroenterology, hepatology and a specialist NAFLD clinic. Overall, there was significant variability in the lifestyle advice given and management of metabolic risk factors, with patients attending an NAFLD clinic significantly more likely to achieve >10% body weight loss and have metabolic risk factors addressed. Following introduction of the NAFLD bundle 50 patients were evaluated. Use of the bundle was associated with significantly better documentation and implementation of most aspects of patient management including management of metabolic risk factors, documented lifestyle advice and provision of NAFLD-specific patient advice booklets.Conclusion The introduction of an outpatient ‘care bundle’ led to significant improvements in the assessment and management of patients with NAFLD in the NEE and could help improve and standardise care if used more widely.