Purpose: The aims of this performance improvement project include the following:

• To start doing liver biopsy in the clinic set up.
• To increase the liver biopsy being performed in the hospital for potential donor hepatectomy.
• To standardize practice of liver biopsy being done across the hospital either in OR, Interventional Radiology or the clinic set up (Level 8A – Adult Liver Clinic).
• To facilitate accommodation of having more potential donors being screened.

Method: The performance improvement project was explained to the nurses and staff are being selected to be part of the initial team for liver biopsy.  Currently liver biopsy for potential donor hepatectomy is performed using OR (Operating Room) slots thru DSU (Day Surgical Unit). Several collaborative meetings were held involving the stake holders ;  Head of the Hepatology Medical Drs , Quality team, Program Director , Assistant Chief of Executive Nursing Department, Liver Clinic HN, OR HN , DSU HN, Informatics ,Infection Control team and Liver team Clinical Instructor. In regards to those meetings held, suggestions and recommendations are laid down, and plans on how to execute the flow of liver biopsy has been properly scrutinized in accordance with the hospital policies and procedures. Selected staff nurses are required to be ACLS and Procedural Sedation qualified. Trainings and education are being conducted to make sure staff nurses are equipped with knowledge and skills to start the Liver biopsy in the clinic. Liver biopsy flow pathway was created and mock simulation was organized, in collaboration with every department involved. Some gaps and concerns are addressed.

Results: The PI project utilizing liver biopsy in the clinic started 2nd week September 2 cases per week and as to date we have 515 cases done. With those cases no major or serious complications has been documented. With a few minor complications were noted during liver biopsy such as hypotension and vasovagal effect. Otherwise all potential donors were being discharged safely. Potential donors were being taken cared of appropriately post liver biopsy.

Clinical relevance: The number of cases will surely helped the organization in having more chances of potential donors being screened that will give back the quality of life of our liver patients requiring transplantation. At the moment, the flow of liver biopsy in the Adult Liver clinic set up is functioning very well and is ongoing, improvements will follow in the process.