517 A retrospective audit into the implementation of CT as the recommended first-line imaging in the investigation of suspected Acute Bowel Obstruction in a Tertiary General Surgical Unit

Abstract

Abstract Introduction The NCEPOD ‘delay in transit’ report 2020 explored the management of patients presenting with Acute Bowel Obstruction (ABO), highlighting delays at all stages of patient care from presentation to management. CT scan as the first definitive imaging was a key recommendation to prevent delay in decision making. The Aim of this audit was to investigate compliance with this key recommendation and consequential delay in decision making and treatment. Methods Data from imaging requests for patients above the age of 16, with a provisional diagnosis of ABO from March-September 2022 was included in the study and analysed. Data analysed included: times of admission, X-ray of abdomen, CT, and time of decision to treat (TDT). The hypothetical time to decision to treat (TDT) was calculated if CT was the first investigation instead of X-Ray; the time of X-ray being performed as the potential time of performance of CT. Delays at each stage of care were calculated. Results Between March 2022 and September 2022, 37 patients were admitted under surgery and diagnosed with ABO. The median TDT when X-ray was done prior to CT was 7 hours 3 minutes (IQR 4 hours 32 minutes to 16 hours 42 minutes). 82% of patients required a CT after X-Ray for definitive decision making. Conclusion Our surgical service is yet to achieve compliance to this NCEPOD recommendation, with consequential delay in decision making. Further education and change of practice are necessary to implement this key recommendation for raising physician awareness and improve care.