Alcohol Pathway

Background: Alcohol use, alongside viral hepatitis and obesity, are leading causes of liver disease. Progression of alcoholic liver disease (ALD) is associated with cirrhosis, hepatic failure, hepatocellular carcinoma, and increased mortality. In 2022, there were 5,776 premature deaths attributed to ALD in the UK. NICE guidance NG50 recommends the use of transient elastography (TE) to assess liver fibrosis and detect cirrhosis in individuals who consume alcohol at harmful levels for several months, enabling early detection. This is particularly relevant for the UK and Jersey populations where hazardous and harmful patterns of alcoholconsumption are prevalent. The early identification of liver disease offers an opportunity for timely intervention and improved clinical outcomes. Aims: This study aims to explore whether patients accessing the Jersey Alcohol Pathway Team (APT) within the Alcohol and Drugs Service (A&D) are appropriately referred for TE in line with NICE NG50 recommendations. Project design: This study constitutes a clinical audit using a etrospective observational methodology. The study uses a total population sampling approach, looking at a sample of 50 patient records, of referrals received by the A&D service in the year of 2025. Findings: The audit revealed that although most individuals presented AUDIT scores between 20-25 and reported prolonged alcohol consumption at harmful levels, there was a low level of documented diagnoses of ALD and a limited number of referrals for TE assessment. Conclusion: The findings suggest suboptimal adherence to NICE Guidance NG50 within the Jersey APT. Furthermore, despite existing evidence of ALD on abdominal ultrasound, documented diagnoses of ALD were limited. To address this gap, the implementation of an Advanced Clinical Practitioner (ACP) led service for the diagnosis and management of ALD and Alcohol use disorders (AUD) is proposed to improve guideline compliance and patient outcomes.

Background: Alcohol use, alongside viral hepatitis and obesity, are leading causes of liver disease. Progression of alcoholic liver disease (ALD) is associated with cirrhosis, hepatic failure, hepatocellular carcinoma, and increased mortality. In 2022, there were 5,776 premature deaths attributed to ALD in the UK. NICE guidance NG50 recommends the use of transient elastography (TE) to assess liver fibrosis and detect cirrhosis in individuals who consume alcohol at harmful levels for several months, enabling early detection. This is particularly relevant for the UK and Jersey populations where hazardous and harmful patterns of alcoholconsumption are prevalent. The early identification of liver disease offers an opportunity for timely intervention and improved clinical outcomes. Aims: This study aims to explore whether patients accessing the Jersey Alcohol Pathway Team (APT) within the Alcohol and Drugs Service (A&D) are appropriately referred for TE in line with NICE NG50 recommendations. Project design: This study constitutes a clinical audit using a etrospective observational methodology. The study uses a total population sampling approach, looking at a sample of 50 patient records, of referrals received by the A&D service in the year of 2025. Findings: The audit revealed that although most individuals presented AUDIT scores between 20-25 and reported prolonged alcohol consumption at harmful levels, there was a low level of documented diagnoses of ALD and a limited number of referrals for TE assessment. Conclusion: The findings suggest suboptimal adherence to NICE Guidance NG50 within the Jersey APT. Furthermore, despite existing evidence of ALD on abdominal ultrasound, documented diagnoses of ALD were limited. To address this gap, the implementation of an Advanced Clinical Practitioner (ACP) led service for the diagnosis and management of ALD and Alcohol use disorders (AUD) is proposed to improve guideline compliance and patient outcomes.