FTP5.7 Championing Benign Biliary Patients in a UGI Tertiary Referral Cancer Centre. Results from a 3 year Quality Improvement Project

Abstract

Abstract Background A biliary quality improvement project (QuIP) was established in 2019 following 3 audit cycles highlighting delays to laparoscopic cholecystectomy (Lap-C) in patients with gallstone pancreatitis. Limited theatre space and prioritisation of high volume cancer work hindered previous efforts to improve the service between 2015 and 2019. The latest phase of the QuIP has introduced a dedicated consultant lead biliary service, a live biliary admission tracking system, increased in-patient Lap-C, implementation of ambulatory pathways and a patient centred integrated care approach. Methods Prospectively collected data from a live biliary tracking system was compared with retrospective audit data from 2015-2019. Key performance indicators were; average time to Lap-C, rate of Lap-C with-in 2 weeks following pancreatitis, inpatient Lap-C rate and out-patient appointments saved. Results 343 patients were managed through inpatient and ambulatory biliary pathways from November 2021-2022. 2 week Lap-C post pancreatitis improved from 27% to 69% (41% as inpatients) with average time to Lap-C improving from 68 days to 13 days. 103 outpatient appointments were save by counselling and pre-assessing patients for Lap-C as inpatients, saving £12360 in outpatient costs. In-patient Lap-C rate improved from 2% to 19% for fit and consenting patients. Conclusion Patients with biliary pathology may be at risk of lower standards of care when treated in centres with a high tertiary UGI cancer burden. A higher quality of care can be achieved for biliary patients through effective patient prioritisation, increasing inpatient Lap-C, the establishment of ambulatory pathways and a robust outpatient tracking system.