Local education measures are insufficient at ensuring timely imaging in acute pancreatitis

Abstract

Abstract Aims The Royal College of Radiologists (RCR) has outlined specific criteria for imaging in acute pancreatitis. The presence of pancreatic necrosis, free intraperitoneal fluid and extensive perihepatic fat stranding is associated with worse outcome. Timely computed tomography (CT) scanning 72 to 96 hours following onset of symptoms leads to more accurate diagnosis of pancreatic necrosis. Furthermore, ultrasound examination of the gallbladder is also recommended within 24 hours of admission to demarcate cause. Methods Two plan-do-study-act (PDSA) cycles were run between January to October 2022 and January to September 2023 in the surgical emergency unit. 50 patients were randomly selected amongst all pancreatitis admissions for each cycle. Outcome measures were percentage of CT scans adhering to optimal timing and percentage of ultrasound scans that were carried out within the first 24 hours. Cycle 1 findings were presented locally to staff as a teaching intervention. Results CT scans were performed in 60% and 66% of patients in cycle 1 and 2, respectively. Of these, 39% and 70% had optimal CT scan timing during cycle 1 and 2, respectively. Furthermore, only 33% of patients had US scans performed within 24 hours of admission during both cycles. Conclusion The above findings suggest that local teaching interventions are inadequate at meeting the recommended standard of 95% compliance defined by the RCR. This is likely due to rotating staff, lack of knowledge and incomplete prompting when ordering imaging. Further audit with an information technology based intervention is suggested to improve compliance.