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Introduction Decompensated liver cirrhosis is a common cause of admission to acute medical units and often progresses to acute-on-chronic liver failure (ACLF), a multi-organ syndrome with a 28-day mortality approaching 30% (1,2). To standardise early interventions and improve cirrhosis management, our Trust adapted the British Society of Gastroenterology evidence-based 24-hour decompensation bundle (3) and embedded it into the electronic record. Despite this integration, local data revealed that awareness of the bundle remained very low, and clinicians reported limited confidence in managing these complex cases. This Quality Improvement project was designed to address these gaps through a two-phase educational programme for Foundation Year 1 doctors – clinicians who first clerk these patients – aimed at raising bundle awareness and enhancing management skills to support better patient outcomes. Central to this initiative is ‘CirrhoSIM’ a high-fidelity simulation series that guides participants through scenarios of variceal bleeding (VB), spontaneous bacterial peritonitis (SBP), and hepatic encephalopathy (HE), reinforcing both escalation decisions and bundle activation within a safe, mentored environment.Methods We surveyed FY1 doctors (n=24) to establish baseline bundle awareness (5%), confidence (mean 1.9/5), and knowledge. We then ran two interventions. Cycle 1 was a one-hour interactive teaching session covering cirrhosis pathophysiology, key complications, ICU-transfer criteria, and step-by-step guide of the care bundle (n=24). Cycle 2 introduced ‘CirrhoSIM,’ a novel simulation series in which pairs of FY1s (n=18) managed VB, SBP and HE under the guidance of a hepatology SpR and consultant receiving real-time scenario support and feedback to mirror clinical practice.Results Pre- and post-intervention surveys captured confidence scores for each scenario, brief knowledge checks, and awareness of both the bundle and escalation pathway, while attendance and free-text feedback served as balancing measures. After teaching, bundle awareness rose from 5% to 94% and self-rated confidence more than doubled. CirrhoSIM maintained these confidence gains and improved ACLF pathway familiarity (7% to 62%), although detailed knowledge scores around ACLF grading and organ-failure criteria remained low, indicating the need for targeted reinforcement.Abstract P84 Figure 1Discussion This two-phase programme markedly enhanced bundle awareness and clinician confidence in decompensated cirrhosis management, demonstrating the value of high-fidelity simulation alongside conventional teaching. Data collection revealed ongoing gaps in clinicians’ understanding of escalation criteria and feedback identified dedicated teaching to improve outcomes in this patient cohort. Our innovative CirrhoSIM session enabled FY1 doctors to rehearse critical scenarios under real-time hepatology guidance, and we plan to expand the opportunity to participate in CirrhoSIM regionally.References Mansour D, McPherson S. Management of decompensated cirrhosis. Clinical Medicine 2018 Apr;18(2):s60–5.Hernaez R, Solà E, Moreau R, Ginès P. Acute-on-chronic liver failure: an update. Gut 2017 Mar;66(3):541–53.