New tests cut liver clinic waiting times by half

NHS Tayside has reduced its liver clinic waiting list by almost half after introducing a pioneering rapid test to identify priority patients.

The enhanced liver fibrosis (ELF) blood test is able to identify the amount of scarring (fibrosis) in the liver and helps clinicians decide which patients need to be seen in the specialist liver clinic for further treatment.

Intelligent liver function tests (iLFTs) were first developed and implemented in Tayside in 2018 by a team led by consultant gastroenterologist and hepatologist Professor

John Dillon and consultant in biochemical medicine Dr Ellie Dow.

The new tests have helped to identify more patients with liver disease and diagnose and treat them at an earlier stage.

Using the automated blood sciences laboratory infrastructure at Ninewells Hospital, the iLFTs estimate the amount of fibrosis in the liver with a ‘rule-in’ and ‘rule-out’ threshold, but some patients in the middle were classed as ‘indeterminate’ and required to be referred to the specialist liver clinic for further investigation.

To help refine this process further, the team in Tayside introduced the ELF score into the iLFT pathway, which more accurately identifies fibrosis by measuring three different molecules in the blood.

This helps decide which patients with ‘indeterminate’ fibrosis estimates should be seen in the specialist liver clinic and which patients can be safely managed by their GP.

Professor Dillon said: “Since July we have performed ELF tests on over 500 patients, of which 44 per cent had an ELF score which showed they can safely be managed in the community.

“This prevents unnecessary anxiety for these patients and reduces clinic waiting times so that patients with serious liver disease can get specialist care more quickly.”