scholarly journals P-P16 Management of acute pancreatitis in a busy district general hospital

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Simon Saldanha ◽  
Aparna Joshi ◽  
Osamah Niaz
Keyword(s):  
Acute Pancreatitis ◽  
Oxygen Saturation ◽  
General Hospital ◽  
Fluid Resuscitation ◽  
District General Hospital ◽  
Antibiotic Use ◽  
British Society ◽  
Blood Profile ◽  
Life Threatening ◽  
Scoring Tool

Abstract Background Pancreatitis is a common surgical presentation and can be life threatening, with complications such as acute respiratory distress syndrome and necrosis occurring. Due to high hospital incidence, it is important to ensure patients are managed appropriately using available guidelines. This audit aims to assess the management of acute pancreatitis in a busy district general hospital and identify areas for improvement to better patient safety. Methods Only cases of acute pancreatitis were used in this audit. Case notes for the period between October and December 2020 were collected respectively. A data collection proforma was created using guidelines from the British society of gastroenterology for the management of acute pancreatitis. Data was then analysed using Excel. Results 23% of cases had documented scoring, with Glasgow-Imrie the only scoring tool used. 41% had documented oxygen saturation. 33% had been reviewed by alcohol liaison team for pancreatitis secondary to high alcohol consumption. No patients were given the guideline’s recommended rate of fluid resuscitation (5-10ml/kg/hr). All patients had amylase/lipase in their blood profile. 80% of patients had antiemetics prescribed should they require them, whilst 95% of patients had opioids prescribed for analgesia. 50% of patients were given antibiotics despite them not being indicated. 18% were kept nil by mouth (NBM) whilst having abdominal pain. Conclusions Our results suggest that guidelines for acute pancreatitis are not adequately adhered to. Many aspects of the guidance were not followed including documentation of oxygen saturation, antibiotic use, IV fluid resuscitation and alcohol liaison review for patients who required review. We have developed a proforma to use for the management of acute pancreatitis to ensure that cases are managed in accordance with evidence-based literature and to make the management of these cases easier. We will reaudit to analyse the effects of our intervention and determine whether there has been an improvement in the management of acute pancreatitis.

Management of acute pancreatitis in a district general hospital: Comparisons with the British Society of Gastroenterology guidelines

Pancreatology ◽  
2012 ◽  
Vol 12 (3) ◽  
pp. e17
Author(s):  
A. Asaad ◽  
M. Gatt ◽  
M. Afzal ◽  
H. Razzak ◽  
R. McLean ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
General Hospital ◽  
District General Hospital ◽  
British Society

scholarly journals AB0903-HPR DURATION OF TELEPHONE CONSULTATIONS AMONGST RHEUMATOLOGY PRACTITIONERS IN A DISTRICT GENERAL HOSPITAL - ADAPTING TO REMOTE CONSULTATION IN A COVID-19 PANDEMIC

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1474.1-1474
Author(s):  
L. Parker ◽  
F. Coldstream
Keyword(s):  
General Hospital ◽  
Controlled Trial ◽  
Clinical Care ◽  
District General Hospital ◽  
British Society ◽  
Nice Guideline ◽  
Face To Face ◽  
Co Morbidity ◽  
Randomised Controlled ◽  
Remote Consultations

Background:The Covid-19 pandemic has resulted in a rapid adoption of remote consultations in order to limit face to face clinical contact wherever appropriate, as recommended by the British Society for Rheumatology. The same clinic templates which existed for face-to-face encounters have been retrospectively adapted, without consideration of any potential difference in duration of consultations. Rheumatology practitioners from a variety of clinical backgrounds work alongside the rheumatology consultants, providing clinical care to patients with both inflammatory arthritis and connective tissue disease.Objectives:To record the duration of all scheduled telephone consultations carried out by advances rheumatology practitioners in a 4-week period.Methods:All scheduled telephone clinic encounters over a 4-week period were timed and the duration recorded in a spreadsheet. Data was collected in real time by all 8 rheumatology advanced practitioners working within the rheumatology department of a district general hospital, following each clinic episode.Results:Data was recorded from a total of 337 clinic appointments. Of these, 317 (94%) were booked as routine, 3 (0.9%) as urgent, 4 (1.2%) were expedited following an advice line contact, and 13 (3.9%) no data was recorded. 28 (8%) of the patients did not answer when contacted. 80 (24%) clinic appointments lasted 15 minutes or less, 186 (55%) lasted 16 - 30 minutes, 37 (11%) lasted 31 - 45 minutes, and 6 (2%) lasted 46 - 60 minutes. The average duration was 22 minutes.Conclusion:Within this department, remote consultations appear to have a similar duration when compared against the traditional clinic template for a fully face-to-face clinic, with some encounters lasting significantly longer than the planned duration. This would appear to differ to telephone consultations used in other settings, such as general practice where the duration is reportedly shorter1. This may be representative of the additional complexity and co-morbidity of a typical rheumatology patient, or due to the multi-faceted nature of a rheumatology follow-up appointment2. Although remote consultations are effective in limiting risk of exposure to Covid-19, they may not offer a quicker or more efficient service compared with the face-to-face model. Further study in this field is required to evaluate this widely adopted new pattern of working.References:[1]Pinnock H, Bawden R, Proctor S, Wolfe S, Scullion J, Price D, Sheikh A. Accessibility, acceptability, and effectiveness in primary care of routine telephone review of asthma: pragmatic, randomised controlled trial. BMJ. 2003 Mar 1;326(7387):477-9. doi: 10.1136/bmj.326.7387.477. PMID: 12609944; PMCID: PMC150181.[2]National Institute for Health and Care Excellence (NICE) (2018) rheumatoid arthritis in adults: management (NICE Guideline NG100). Available at https://www.nice.org.uk/guidance/ng100 [Accessed 05 January 2021].Disclosure of Interests:None declared

scholarly journals Colonoscopy at a Combined District General Hospital and Specialist Endoscopy Unit: Lessons from 505 Consecutive Examinations

2002 ◽  
Vol 95 (4) ◽  
pp. 194-197 ◽  
Author(s):  
Siwan Thomas-Gibson ◽  
Catherine Thapar ◽  
Syed G Shah ◽  
Brian P Saunders
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
British Society ◽  
Completion Rates ◽  
Endoscopy Unit ◽  
Pain Scores ◽  
Training And Supervision ◽  
Long Term Follow Up

Provisional reports from the Intercollegiate British Society of Gastroenterology National Colonoscopy audit show completion rates of 57–77%for the procedure and poor levels of training and supervision. We prospectively audited all aspects of colonoscopy performed at a combined district general hospital and specialist endoscopy unit. Details of referral, examination, endoscopist, complications and follow-up were recorded and patients were sent questionnaires for long-term follow-up. 505 patients (246 male) underwent colonoscopy by 27 different endoscopists. Their median age was 57 years (range 13–92) and 93%were outpatients. 64% patients were symptomatic and 36%were having surveillance or follow-up colonoscopy. The overall caecal intubation rate was 93%, with little difference between surgeons, physicians and experienced trainees (89%, 92%, 94%) and specialist endoscopists (98%). In only one case was an inexperienced trainee (<100 procedures) unsupervised. Pain scores estimated by the endoscopist were well matched with those given by the patient—medians 29 and 26 (maximum 100) respectively. Median satisfaction score was 96 (maximum 100). Polyp pick-up rate was 26.9%and there were 11 new cancers. 16 (3%) minor immediate complications were recorded—5 oversedation, 6 vasovagal attacks, 3 polypectomy haemorrhages and 2 mucosal injuries (neither requiring treatment). 3 patients died within 6 months of follow-up but no death was colonoscopy related. Completion rates in this setting were adequate for all endoscopists studied. Patient satisfaction with the procedure was high and very few immediate or long-term complications were encountered.

scholarly journals 1333 A Retrospective Audit Against National Standards and Guidelines of The Management and Outcomes of Acute Pancreatitis in A London District General Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Tytler ◽  
L Nip ◽  
C M Borg
Keyword(s):  
Acute Pancreatitis ◽  
Correct Diagnosis ◽  
District General Hospital ◽  
National Standards ◽  
British Society ◽  
Definitive Treatment ◽  
Gallstone Pancreatitis ◽  
Post Discharge ◽  
Retrospective Audit ◽  
Threatening Condition

Abstract Introduction Acute pancreatitis (AP) is a potentially life-threatening condition. The audit looks at its management and compares it versus the British Society of Gastroenterology guidelines. Method The study retrospectively assessed plans and results for patients with AP over 4 months. Targets were mortality rate below 10% (&lt;30% for severe cases), correct diagnosis at 48h from admission, ultrasound examination of the gallbladder within 24h of diagnosis, severity stratification within 48h of diagnosis, cause established in over 80%, management involving intensive care settings for severe cases and definitive treatment of gallstone pancreatitis in less than 14 days. Results 34 patients were identified, 3(8.6%) had severe acute pancreatitis (SAP). Mortality was 2.9% overall (33.3% in SAP). AP was diagnosed within 48h of presentation in all cases with severity stratification undertaken in 91.2%. Determination of aetiology was achieved in 82.4% with the rest documented as unknown/idiopathic/requiring further investigations post-discharge. Ultrasound studies were undertaken in 58.8% of cases but, as the hospital did not offer ultrasonography on the weekend, 41.2% actually had this type of imaging performed within 24h. Within those who did not have ultrasound at 24h, 50% had had computer tomography imaging. All SAP cases were discussed with intensivists and 7.1% of gallstone pancreatitis underwent definite treatment within 2 weeks. Conclusions Current practice in the hospital mostly meets the reference standards. However, the percentage undergoing definitive treatment of gallstone pancreatitis is low. We aim to re-audit in 4 months following meetings with local surgical leads to discuss implementation of a suitable pathway.

scholarly journals 522 Audit of Acute Lower Gastrointestinal Bleed Management in a District General Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Mallick ◽  
R Salem ◽  
A Payne
Keyword(s):  
Retrospective Study ◽  
General Hospital ◽  
Current Practice ◽  
Length Of Hospital Stay ◽  
District General Hospital ◽  
British Society ◽  
Median Length ◽  
Gastrointestinal Bleed ◽  
Lower Gastrointestinal Bleed ◽  
One Year

Abstract Introduction Acute Lower Gastrointestinal Bleed (ALGIB) is a common emergency surgical referral. This project aims to audit current practice at a district general hospital against new British Society of Gastroenterology guidelines, which gives recommendations regarding assessment (Oakland score), investigation and management. Method A retrospective study was undertaken over one year (2019) of patients presenting to A&E or referred via GP with ALGIB. Patients were identified through the coding department. An online proforma was used for data collection, which was analysed with SPSS. Results 76 appropriate patients identified. Median length of hospital stay was 1 day. 10 patients (13.2%) scored ≤8 (probability of safe discharge 95%), 19 (11.8%) patients scored ≤9 (probability of safe discharge 93%) and 57 patients (75%) scored ≥10. 19 patients discharged the same day, of which 3 (15.8%) scored ≤8 and 8 (42.1%) scored ≤9. 23 patients admitted overnight, of which 5 (21.7%) scored ≤8 and 6 (26.1%) scored ≤9. Of 66 patients classified as ‘major’, 41 (62.1%) did not have a colonoscopy. Conclusions Introduction of a scoring mechanism and disseminating guidelines will enable GPs and A&E doctors to safely discharge ALGIB patients with appropriate outpatient investigations and reduce surgical admissions. There is currently poor compliance with inpatient investigations.

scholarly journals An audit of management of acute pancreatitis in a networked district general hospital

2014 ◽  
Vol 12 ◽  
pp. S98
Author(s):  
Mohammed Elsayed ◽  
James Pine ◽  
John Wayman ◽  
John Robinson
Keyword(s):  
Acute Pancreatitis ◽  
General Hospital ◽  
District General Hospital
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