EP.FRI.554 How long do patients wait for emergency laparoscopy? A local audit of service

Aim Anecdotal experience suggested patients undergoing diagnostic laparoscopy for appendicitis faced long pre-operative waiting periods. This project was undertaken to quantify the situation and determine how long patients were waiting for surgery. National guidelines recommend patients can reasonably wait 6-18 hours for surgery, as per NCEPOD classification of intervention (appendicitis considered to fall under urgent 2b category). Method A retrospective audit of 39 patients listed for diagnostic laparoscopy or appendicectomy during November 2019 was performed. Clinical notes and electronic records were reviewed to determine the timeline of clinical decision making and patient’s arrival in theatre. Operative and histopathology findings were also noted. Results The majority of patients (61%) underwent surgery within 18 hours of a documented decision to operate. Average wait was 17.5 hrs (mean). Longest wait was 41 hours (excluding isolated outlier). Documentation of decision to operate was noted to be poor (undocumented in 5 cases) and in some cases the patient was booked before a documented decision to operate. Variation between the operative and histopathological diagnosis of appendicitis was apparent. Conclusions The findings are re-assuring that once the decision was made to operate most patients had surgery within 18 hours. However, there is still room for improvement with regards to timeliness and documentation. The discrepancy between operative and histological findings highlight the challenge of diagnosing appendicitis accurately.