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Introduction Decompensated liver cirrhosis is a complex multisystem disorder which requires immediate and appropriate medical attention due to its high morbidity and mortality rate. Therefore, early intervention for these patients is crucial. British Society of Gastroenterology (BSG) and British Association for the Study of Liver (BASL) developed a cirrhosis care bundle, aiming to improve overall outcome and mortality. The bundle lays out the guidance to ensure appropriate investigations and interventions are carried out early for these patients. We conducted a 3 cycle QI study in Causeway hospital aiming to encourage the use of BASL bundle, thereby improving the overall outcome of the patients presenting to the hospital with decompensated cirrhosis.Methods This quality improvement project consisted of three retrospective audit cycles conducted at Causeway Hospital using ECR (Electronic Care Record) and patient notes. The first, second and third cycles included all the patients who were admitted to Causeway Hospital with decompensated cirrhosis during January to December 2019, June 2020 to May 2021 and June 2021 to May 2022 respectively. Interventions included implementation of BASL Cirrhosis bundle following the first study cycle followed by regular departmental teachings as well as gastroenterology inductions during each changeover, along with conduction of skills lab training for better paracentesis competence. In addition, an SBP care bundle and a 20% HAS prescription chart were developed to enhance compliance with recommended management.Results Mean patient age was comparable across the cycles with 57.7,57.2,59.5 for the first, second and third cycle respectively. BASL cirrhosis bundle use increased from 0% to 53% and 84%, leading to exemplary improvements in initial investigations, sepsis recognition, management of gastrointestinal bleeding and acute kidney injury, prompt diagnostic paracentesis and initiation of antibiotics followed by identification and management of hepatic encephalopathy. This has led to reduction in average length of stay from 15 to 12 days following bundle implementation and remained stable thereafter. Thirty-day mortality reduced from 16% to 9%, with a further reduction to 4.5% in the final cycle.Conclusions This quality improvement project has demonstrated that the implementation and improved adherence to the cirrhosis bundle has resulted in sustained improvement in the overall management and outcome of patients with decompensated liver cirrhosis.References https://www.bsg.org.uk/clinical-resource/bsg-basl-decompensated-cirrhosis-care-bundle-first-24-hours.Juniper M, Smith N, Kelly K, Mason M, 2013. Measuring the units. A review of patients who died with alcohol-related liver disease. NCEPOD. Available from: https://www.ncepod.org.uk/2013report1/downloads/MeasuringTheUnits_FullReport.pdf.