2805 Targeted Interventions Improving Compliance With Guideline-Based Care in Acute Pancreatitis

Abstract

INTRODUCTION: Acute pancreatitis (AP) is the 3rd leading cause of GI related hospitalizations nationwide. In an effort to improve guideline-based care at our institution, we acquired retrospective data from 247 patients admitted to our institution between April 1, 2015 to September 30, 2017 with AP. We identified multiple areas in which to improve care based on the American College of Gastroenterology (ACG) Guidelines: intravenous fluid (IVF) resuscitation, right upper quadrant ultrasound (RUQ-US) use, and antibiotic stewardship in patients admitted with AP. We aimed to increase the percentage of AP patients who receive adequate IVF resuscitation in the first 24 hours from 6.4% to 50%, increase the RUQ-US rate from 59.5% to 80%, and decrease the rate of inappropriate antibiotic use from 24% to 10%, by April 1, 2019. METHODS: Within the internal medicine department, a quality improvement group was assembled. Barriers to implementing guideline-based care within our target areas were identified. We then implemented interventions aimed at improving performance in our three focus areas. The interventions included: house staff education, development and implementation of an AP admission order set within the electronic medical record (EMR), meeting with the emergency department to encourage early fluid resuscitation, distribution of a management flowsheet to house staff work rooms, and the antimicrobial stewardship program (ASP) including patients with AP who meet criteria for inappropriate use (on antibiotics for >48 hours without evidence of intrapancreatic or extrapancreatic infection) in their EMR based communication. We tracked our progress utilizing a real-time patient monitoring software. RESULTS: On April 1, 2019, a total of 35 patients were captured after the start of our interventions. Appropriate IVF resuscitation [defined as >250cc/hr of normal saline or lactated ringers (6L in the 1st 24 hours)] improved from 6.4% to 20%. RUQ-US obtained on admission improved from 59.5% to 71.4%. Inappropriate antibiotic use decreased from 24% to 11.4%. CONCLUSION: While improvements in appropriate IVF resuscitation, RUQ-US rate, and antibiotic stewardship were noted, we have not yet met our goals. We aim to build on this progress through increased utilization of the AP order set, and the ASP will continue to monitor and intervene for inappropriate antibiotic use in AP patients. We intend to evaluate pre and post intervention 30-day readmission rates and length of stay.