HPB O08 Championing benign biliary patients in Emergency General Surgery: 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 other urgent care priorities hindered efforts to meet other biliary key performance indicator targets between 2015 and 2019. The last phase of the QuIP has introduced a dedicated consultant lead biliary service, a live biliary patient 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 523 patients were managed through inpatient and ambulatory biliary pathways from November 2021-June 2023. 2 week Lap-C post pancreatitis improved from 27% to 79% (43% as inpatients) with average time to Lap-C improving from 68 days to 13 days. 191 outpatient appointments were saved by counselling and pre-assessing patients for Lap-C as inpatients, saving £22920 in outpatient costs. In-patient Lap-C rate improved from 2% to 19% for fit and consenting patients. Conclusions 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.