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CAN EVIDENCE BASED PROFORMA’S AND DEPARTMENTAL AUDIT IMPROVE THE MANAGEMENT OF ACUTE PANCREATITIS?
Author(s) -
Lienert A. R.,
Connnor S. J.,
Bagshaw P. F.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04119_4.x
Subject(s) - medicine , acute pancreatitis , gallstones , pancreatitis , audit , etiology , univariate analysis , interim analysis , presentation (obstetrics) , general surgery , multivariate analysis , surgery , randomized controlled trial , management , economics
Purpose To assess whether evidence based proforma’s and departmental audit can improve the management of patients with acute pancreatitis as compared to published international guidelines. Methodology From June 2005 all patients admitted with acute pancreatitis were required to have an evidence based proforma prospectively completed. In March 2006 an interim analysis was performed and presented to the department of General Surgery highlighting areas which deviated from published guidelines. Key clinical indicators were analysed pre and post presentation. Results Two hundred and eighty one patients were admitted with acute pancreatitis, 168 (60%) of whom were analysed in the interim analysis. The median (range) age was 59 (12–96) years and the aetiology was gallstones in 149/281 (53%) patients. 140/281 (50%) patients had predicted severe pancreatitis, but there was no difference pre and post departmental presentation (85/168 (51%) vs. 56/113 (50%), p = 0.865). On univariate analysis following the departmental presentation there was a significant reduction in the number of CT scans performed (76/168 (45%) vs. 30/113 (27%), p = 0.002), an increase in the number of patients undergoing definitive treatment for mild biliary pancreatitis (36/65 (55%) vs. 35/43 (81%), p = 0.006) and a reduction in mortality (9/168 (5%) vs. 1/113 (1%), p = 0.047). Multivariate analysis confirmed departmental presentation as independent prognostic factor in reducing the number of CT scans (p < 0.001) and increasing definitive treatment of mild biliary pancreatitis (p = 0.02). Conclusions For Audit to change practice evidence based protocols alone are not sufficient. Feedback to clinicians would appear to be a powerful motivator of change.