P17 Acute cholecystectomy service quality improvement

Abstract

Abstract Introduction Early cholecystectomy <8 days from acute biliary presentation results in improved outcomes. Guidelines suggest >80% of eligible patients should undergo this. Following CholeQuic-ER, evaluating biliary care nationally, HES for this trust showed 20% compliance. Methods Prior to CholeQuic-ER, audits evaluated current practice - referrals, cholecystectomy <8 days, elective waiting lists (WL), HES compared with clinical practice, weekend abdominal ultrasound service (USS). Interventions included stakeholder consultation (A&E/radiology/surgeons/theatre). A pathway encompassing current guidelines was disseminated via education, trust induction and a protocol including increased USS provision (4 weekday and 2 weekend patients/ day), theatre (1 session/week) and senior clinician led coding. Service was re-evaluated. Results Audit of HES showed 60% of patients were incorrectly coded. Of correctly coded, 58% of eligible patients received cholecystectomy <8 days. 21% of patients on WL had previous attendance(s) for biliary pathology, 39% were not referred for surgery. 70% of biliary weekend USS requests were not performed. Areas for improvement are referral for surgery, timely USS, theatre capacity and coding. Post intervention, 100% of eligible patients underwent cholecystectomy <8 days (joint-best UK outcome). No patients on WL had an emergency admission. Our ‘Best in Study’ award from CholeQuic-ER was confirmed with HES. Conclusion Results confirm significant quality improvement for patients presenting with acute biliary pathology. From an initial 20% compliance rate according to HES (58% when corrected for coding error), we achieved 100% of eligible patients receiving cholecystectomy <8 days. These interventions could be disseminated to gain better outcomes nationally. Take-home message This project showed significant quality improvement for patients presenting with acute biliary disease. These interventions could be disseminated to gain better outcomes for patients nationally.