SP 2.15 The CLARITY Trial: Evaluating an Educational Intervention for Surgical Teams to Improve Appendicitis Pathways
Fatima Mansour, Dion Morton, Clarity Collaborative, Mohammad AlabdulrahmanAbstract
Background
Appendicitis is the commonest general surgical emergency worldwide. Despite its frequency, UK patient outcomes remain suboptimal, and care pathways vary significantly between hospitals. Many patients admitted with suspected appendicitis are either monitored without undergoing surgery or receive a negative appendicectomy for a histologically ‘normal’ appendix. This pattern indicates gaps in diagnostic performance and opportunities to optimise patient care pathways.
Aim
To determine whether implementation of an evidence-based educational intervention can reduce unnecessary hospital admissions and improve patient outcomes in right iliac fossa care pathways.
Methods
The CLARITY Trial (SurgiCaL educAtion to Reduce IncorrecT care pathwaYs and enhance patient outcomes in right iliac fossa pain) is a national, implementation-effectiveness, cluster-randomised controlled trial running across 50 sites. Each site served as a cluster and was randomised in a 1:1 parallel design. Intervention sites implemented a digital educational module for surgical teams promoting evidence-based assessment of suspected appendicitis. Control sites continued standard care. Data collection was conducted in 8-week blocks with a 30-day follow up. In parallel, a qualitative study using a world café methodology was undertaken with multidisciplinary participants to explore perceived facilitators and barriers to implementation of the intervention.
Outcomes
The primary outcome was the non-operative admission rate. Secondary outcomes centred on patient safety, including negative appendicectomy rate, missed diagnosis, and readmission. Qualitative outcomes included thematic analysis of barriers and facilitators to implementation.
Results
Main trial and qualitative data analysis are ongoing.
Conclusion
This is the first UK trial evaluating whether an educational intervention can standardise emergency surgical pathways and improve outcomes in suspected appendicitis. The embedded qualitative study will provide additional insights into the facilitators and barriers to implementing evidence-based practices across complex emergency settings.