849 Quality Improvement in the Service Delivery of Early Laparoscopic Cholecystectomy (LC) for Acute Cholecystitis (AC)

Abstract

Abstract Aim Acute gallstone disease comprises 30-40% of emergency general surgery workload. Delayed cholecystectomy is related to increased readmissions, biliary complications, and costs. BSG, AUGIS and NICE guideline advocate early Laparoscopic Cholecystectomy (LC). The aim of this Quality Improvement (QI) project is to establish an early LC service in a tertiary hospital in central London, based on national QI Collaborative led by Royal College of Surgeons (RCS). The objectives are assessing existing management, developing strategies, and measuring outcome. Method The management was evaluated including surgeons’ preferences and operating barriers. Strategies were developed through process mapping and stakeholder engagements. Following the implementation, admissions including time to surgery, and reasons for non-compliance, were recorded. The intervention period was set in 4 phases between September 2019 and November 2020: Plan, Improve, Pause and Restart. The sustainability of change was monitored between January 2021 and October 2022. Results 282 AC cases were admitted during intervention period and 68% (194) were fit and consented for surgery. The rate of early LC within 8 days increased from 11% to 61%. During the “pause” phase, the intervention was stopped, and early LC rate dropped to zero, demonstrating the importance of continuous application of strategy. The sustainability was shown during the monitoring period; 343 cases were admitted, 140 (41%) fit for surgery, 62 had surgery within 8 days (43%), and 77 within 14 days (54%). Conclusions The QI study significantly improved the urgent LC rate and received the RCS prize. Sustainability was demonstrated with continual reviews and adaptations.