656 Improving Practice in Acute Pancreatitis Management at a District General Hospital
S Mittal, G Slater- Surgery
Abstract
Aim
Appropriate management of acute pancreatitis is essential, as this condition is associated with a high mortality rate. This clinical audit aimed to improve the initial management of acute pancreatitis in patients presenting to University Hospital Wishaw in line with current guidelines between June 2021 and August 2022.
Method
A retrospective cohort analysis was performed for acute pancreatitis patients discharged between 01/06/21 and 01/12/21. Management was compared against NICE, British Society of Gastroenterology and Royal College of Surgeon’s audit standards which encompass risk stratification, investigation, and management. To improve and standardise care amongst staff, departmental teaching and a management pro-forma were implemented in April 2022. Repeat prospective data collection was performed from May to August 2022.
Results
There were a total of 73 patients included in Cycle 1, and 44 patients in Cycle 2. There was an improvement in all ten audit standards measured. Appropriate investigation into pancreatitis aetiology improved from 25% to 50%, with an 83% reduction in clinicians assuming alcohol-induced pancreatitis without suitable investigation of alternate causes. Initial risk stratification of patients improved from 36% to 52% and severity assessment increased from 4% to 36%. The provision of nutritional support to appropriate patients improved by 35%. Comparison of sub-cohorts revealed that adherence with the pro-forma showed measurably better compliance with standards.
Conclusions
The implementation of teaching and a management pro-forma demonstrated an improvement in standardisation of care. Specifically, use of a visual aid has been shown to better standards. Future cycles could focus on improvement of the pro-forma, and increased compliance.