Advancing Quality NHS Advancing Quality Alliance

Alcohol Related Liver Disease

‘Alcohol related liver disease (ARLD) refers to liver damage caused by alcohol misuse. It covers a range of conditions and associated symptoms. ARLD does not usually cause any symptoms until the liver has been severely damaged. When this happens, symptoms include: feeling sick, weight loss, loss of appetite, yellowing of the skin and the vomiting of blood.’

NHS Choices

Through research, clinical input and clinical guidelines Advancing Quality has developed seven measures that, when applied at the appropriate time, can greatly increase the outcomes for patients. Advancing Quality uses these measures to monitor the quality of care given to patients across the North West with the aim of improving standards and reducing variation in care.

ARLD was launched in January 2015. Participating trusts had a three month data collection period to ensure their systems were accurately recording the care patients received. ARLD became part of the AQ conditions in April 2015.

Data for your local hospital will be available by February 2016.


1. Early warning score calculated and recorded within 60 minutes of arrival at hospital.

An assessment and recording of the severity of your condition ensures any delays in care are reduced.

2. Alcohol misuse screening to be carried out within four hours of arrival to hospital

Alcohol screening can identify hazardous drinkers and those patients at risk of acute alcohol withdrawal. With this identified treatment can be given to patients that may reduce the need for sedation.

3. Antibiotics and blood vessel thinning medication should be given within four hours of suspected bleeds from your veins

Some patients with alcohol related liver disease may experience rupturing of veins and bleeding due to increased blood pressure. Antibiotics should be given to reduce the risk of infection due to the bacteria in your gut entering your bloodstream, Terlipressin should be given to reduce the size of any enlarged veins, helping minimise the risk of further bleeding.  

4. Intravenous delivery of vitamins b and c within 6 hours of your arrival

Water soluble vitamins should be given through a drip within six hours of hospital arrival. Pabrinex contains water soluble vitamins (specifically vitamin B and C), which can be depleted in patients with ARLD. These vitamins are not produced naturally within the body so it is essential they are replaced through this method.

5. Blood test results should be available within eight hours of arrival at hospital

Patients with ARLD are at risk of renal impairment, sepsis as well as bleeding from the gastro-intestinal tract. The timely return of blood test results can help identify these complications and ensure they are managed appropriately.

6. Procedure to drain fluid within eight hours of hospital arrival

An ascetic tap helps drain excess fluid from the abdominal cavity, draining this fluid will help alleviate any respiratory distress or abdominal pain. Clinical staff can also perform analysis on the fluid to identify and treat any medical conditions such as cirrhosis and severe liver disease. You will only have this if it is applicable.

7. Admission to a specialist ward or have a specialist review within 48 hours of hospital arrival

The complexity of medical conditions normally evident in patients with ARLD mean a review by specialists or direct care on specialist gastroenterology or hepatology wards aid in the treatment of the medical conditions.

8. Seen by or referred to alcohol services prior to discharge

Being seen by alcohol services can help manage your condition once you are discharged and lead to better outcomes such as a shorter length of stay and a reduced risk of readmission.
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