Improving Hepatocellular Carcinoma Surveillance in Ambulatory Hepatology: A PDSA Quality Improvement Initiative

Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related mortality worldwide. Despite established guidelines recommending semiannual surveillance for high-risk patients, real-world adherence remains inconsistent. Gaps in healthcare personnel knowledge and care coordination are recognized contributors to this implementation failure. Methods: Under IRB review, a quality improvement project using the Plan-Do-Study-Act (PDSA) framework was conducted in an ambulatory liver clinic in the southwestern United States. One PDSA cycle was completed. Retrospective and prospective chart reviews (n = 50 charts each) were conducted to assess HCC surveillance ordering and scheduling rates. Thirty healthcare personnel completed investigator-developed pre- and postintervention surveys measuring knowledge and perceptions. Intervention: A structured educational session grounded in current American Association for the Study of Liver Diseases (AASLD) surveillance guidelines was delivered to the full interdisciplinary clinic team, incorporating clinic-specific compliance data and role-specific coordination responsibilities. Results: Knowledge scores improved significantly from a mean of 41.67% to 95.33% (t [29] = -20.27, p < 0.001, d = 3.70). Perception scores improved (Wilcoxon z = -4.30, p < 0.001). Surveillance ordering increased from 88% to 94% and scheduling from 60% to 80%. Conclusions: A single structured educational PDSA cycle was associated with significant improvements in healthcare personnel knowledge and perceptions and with improved ordering and scheduling of HCC surveillance imaging. Postintervention imaging completion and result review rates were not assessed within the available follow-up period. Run chart monitoring of surveillance metrics across subsequent PDSA cycles is planned to evaluate sustainment and guide iterative improvement.