Improving the management of acute pancreatitis in a district general hospital

Abstract

Acute pancreatitis is a common problem seen in the United Kingdom, with an incidence of 56.6 per 100,000 population.[1,2,3] Optimising management has been shown to reduce mortality and morbidity, and the British Society of Gastroenterology (BSG) published revised guidelines in 2005 to standardise treatment for this potentially life threatening condition.[4]The aim of this quality improvement project was to investigate and improve the initial management of acute pancreatitis in patients presenting to the Great Western Hospital (GWH) in Swindon between November 2012 and July 2013.Patients presenting to the surgical team during this time with a diagnosis of acute pancreatitis were identified for the initial data collection. Notes were prospectively reviewed and data collected allowing a comparison between management in GWH against BSG guidelines. Following this stage, a pro forma based on the 2005 guidelines was created and implemented, with the aim of raising awareness and standardising care among surgical staff. Following implementation of the pro forma, data collection was repeated between May and June 2013 to assess the impact of the intervention.Results revealed an improvement from 93% to 100% of patients receiving the correct diagnosis within 24 hours of presentation. Severity stratification within 48 hours of diagnosis improved from 75% to 88% and identification of aetiology also improved from 64% to 74%.The implementation of an acute pancreatitis management protocol and education of junior surgical staff has been shown to improve compliance with BSG guidelines at the GWH, and ultimately aims to improves patient care and outcomes.

Quality Gaps in Management of Acute Pancreatitis

“…Thus, there exists a great need to address barriers to adherence to guidelines with a targeted approach. Crowther et al 13 performed a quality improvement project at a hospital in the United Kingdom that targeted patients admitted with AP to the surgical service. A pro forma based on guidelines was created, and an educational and awareness session was held for all the surgical teams.…”

“…They concluded that there was a positive shift in compliance with guidelines after this quality improvement project, specifically in regard to obtaining the correct diagnosis and documenting severity and etiology of pancreatitis. 13 Our recommendations based on the findings of our research project include education of internal medicine, surgical, and emergency room residents, because at our teaching hospital, most of the initial workup is performed by the residents. Our specific recommendations include lectures for emergency room residents regarding indications for CT scans when a diagnosis of mild AP can be made based on clinical presentation and laboratory values, as most of the CT scans on admission are ordered by the emergency room.…”

Relationships between Metabolic Comorbidities and Occurrence, Severity, and Outcomes in Patients with Acute Pancreatitis: A Narrative Review

“…The 2012 revised Atlanta classification of pancreatitis divides the disease into the categories of mild, moderate, or severe. Severe AP has a significant risk of mortality (up to 40%), with the greatest mortality risk in patients with infected pancreatic necrosis [2]. Successful management of AP is challenged by the limited treatment options and the high mortality rates.…”

Cholecystectomy in mild acute biliary pancreatitis: The sooner; the better

“…For all these reasons, management of acute pancreatitis should fall under the "bundle of care" model of organization, as has been the case with other complex processes such as sepsis, cerebrovascular accidents, and myocardial infarction, in all of which this principle has been applied, with a resulting improvement in clinical outcomes with lower healthcare costs (avoiding the overuse, underuse and misuse of resources) together with increases in patients satisfaction (21)(22)(23)(24)(25) …”