225 The Management of Acute Cholecystitis in a District General setting: An Audit of Practice

Abstract

Abstract Aim The benefits of laparoscopic cholecystectomy during index admission with acute cholecystitis (AC) are multiple. As such, current NICE guidelines dictate that adults with AC undergo laparoscopic cholecystectomy within 1 week of diagnosis. However, significant variation exists with regards to the management of such patients. Here we present the results of an audit of practice at a UK district general hospital and suggest that this standard can be achieved regardless of hospital. Method Electronic database search at Salisbury District Hospital over a period of 12 months to identify all patients with a coded diagnosis of AC. Electronic Discharge System (EDS) was consulted to assess whether patients underwent laparoscopic cholecystectomy within 7 days of diagnosis. Notes were reviewed for all patients who failed to meet this target to ascertain reasons why. Results Of the 336 patients coded as AC 8 were excluded due to incorrect coding leaving 328. 285 patients (87%) underwent laparoscopic cholecystectomy within 7 days. Of the 43 that did not, 31 (65%) had clinically justified reasons for delay. 285/297 (96%) patients met the NICE standard. Conclusions At Salisbury District Hospital 87% patients presenting with AC underwent laparoscopic cholecystectomy within 7 days. Common reasons for failure included: Awaiting further investigation (i.e., ERCP / MRCP), unfit for operative management, patient choice. Excluding justifiable reasons 96% of patients met NICE standards. Poor documentation was the most common cause for failure. Subsequent education and re-audit showed significant improvement. This audit exemplifies that NICE standards for the management of AC can be achieved in a district general setting.