482 A closed loop audit showing learning from the National Audit of Small Bowel Obstruction at a District General Hospital

Aims

The National Audit of Small Bowel Obstruction (NASBO) was a prospective study in 2017 that gave recommendations for small bowel obstruction (SBO) management. Those were; early CT, increased use of water soluble contrast for prognostic and therapeutic purpose, early assessment of nutritional status and involvement of nutritional specialists. Our DGH had not been part of this study so we wanted to compare our practice.

Method

We identified 35 patients from admissions records with SBO over an eight week period and reviewed their online records. We presented the findings of our practice in comparison to NASBO at an Audit and Governance meeting, reiterating the recommendations of NASBO. We closed the loop on this audit one year later, identifying 18 patients on reaudit.

Results

Referrals; ED: (NASBO/ 1st Audit/ Reaudit) 68%/91%/95%, GP: 18%/6%/0%.

Aetiology; herniae 19%/50%/16%, adhesions: 54%/25%/61%.

Management; early surgery: 24%/33%/22%, Conservative: 49%/58%/66%, Delayed surgery: 20%/9%/11%.

Radiology Assessment; CT: 80%/88%/94%, AXR + CT: 65%/75%/88%, Water soluble contrast: 21%/12%/44%, Average days to CT: 2.2/0.18/0.43.

Nutrition; Identified as Malnourished: 32%/6%/5%, No oral intake >5days: 49%/44%/17%, Parenteral Nutrition: 14%/6%/17%.

Outcomes; Death: 8%/9%/10%, Readmission: 13%/0%/22%.

Conclusion

Our results show a lot of similarity to NASBO's despite low admissions. Our department improved upon already high CT rates although we increased our percentage receiving both AXR + CT, ergo higher radiation received. There was a marked increased percentage receiving water soluble contrast, our standout improvement. There was no improvement with our nutritional assessment though an increased percentage received parenteral nutrition.