Clinical

Acute management

Acute Jaundice

Background

  • Jaundice is an uncommon presenting complaint that is frequently indicative of severe underlying illness
  • A small proportion of jaundice in well people is due to medically trivial disorders such as Gilbert’s syndrome . This is diagnosadble without secondary care referral.
  • Alarm symptoms in the patient presenting with jaundice include vomiting, fever, confusion, weight loss – such patients require immediate hospital referral via the hepato-biliary 2ww system or if there are serious symptoms and a worry about acute liver failure or sepsis via acute hospital admission.

Patient View

  • Upper abdominal pain, vomiting and jaundice are frightening symptoms and require prompt investigation
  • Patients fear that they may have cancer

Current Practice

  • The vast majority of patients with jaundice are referred to secondary care
  • Immediate investigations include an abdominal ultrasound to exclude biliary obstruction. The presence or absence of a dilated biliary system determines the nature of further investigation

Recommended Practice and Opportunities for Integrated Working

  • Commissioners should ensure that patients with jaundice have access to the 2ww service, ideally being seen within 7 days, preferably in a specific jaundice clinic with access to investigations such as USS and in a centre able to deal with all the detected pathology.

Opportunities for Savings

  • More efficient streamlined pathways of care
  • Avoidance of duplication of investigation

Quality Indicators (Outcomes)

  • Application of screening tests in primary care
  • Rapid response to alarm symptoms
  • Delay before diagnosis
  • Time to see a hepatologist or specialist trained in liver disease
  • Days off work
  • Patient satisfaction

Social Policy & Understanding

  • Provision of efficient pathways of care
  • Education of all health care workers and professionals in the significance and differential diagnosis of jaundice

References