HBV can lead to serious complications but the disease is generally asymptomatic. Homerton University Hospital has a large cohort of treatment naïve HBV patients requiring long term surveillance. Patients were being seen for follow-up on a six-monthly basis primarily to organise surveillance investigations, which impacted upon follow-up waiting time for other conditions and risked delaying surveillance investigations if clinics were cancelled or appointments missed.

We created an electronic ‘virtual surveillance pathway’ commencing March 2018 based upon European guidelines. Patients triaged to this pathway are recalled by text message and postal invitation for Hepatocellular Cancer surveillance ultrasound, with blood tests and elastography performed on the same visit when required. If a focal liver lesion is detected on ultrasound, cross-sectional imaging can be immediately organised by the duty radiologist. results are reviewed in an electronic virtual clinic by a Consultant or Clinical Nurse Specialist with early recall to clinic or organisation of the next cycle of surveillance as dictated by results. Outcomes are electronically shared with the GP and patients receive a hard copy. The pathway is coordinated on the electronic patient record with patients booked into a timetabled ‘paper clinic’ after each cycle of surveillance tests.

Results

• 168 patients were recruited in the first year, saving 336 outpatient appointments.

• Cancellation or non–attendance for surveillance investigations was less than 5% compared to just over 10% for conventional outpatient consultation.

• Liver clinic new to follow–up ratio improved from 14:22 to 16:16.

• Routine follow–up waiting time fell to 13 weeks.

• All respondents reported they were ‘very satisfied or fairly satisfied’ with the service.

ResultsA virtual HBV pathway can deliver safe, evidence-based and timely surveillance with a high degree of patient engagement and satisfaction.