P265 “One Stop HPB clinic” service in North East of England at a district general hospital

Abstract

<h3>Introduction</h3> The provision of Hepatopancreaticobiliary (HPB) services remains variable across most non tertiary HPB hospitals in the UK. Currently most hospitals in UK don’t have a gastroenterologist with a subspecialist interest in HPB disease. There is a growing concern that lack of expertise in the field of HPB medicine can lead to suboptimal care of these complex group of patients in a DGH setting (<i>1)</i>. Development of a dedicated One stop multidisciplinary HPB clinic may allow stream lining of patient care thereby improving outcomes. A joint one stop weekly HPB clinic (Gastroenterologist with HPB interest, Dietician, Specialist nurse) was setup in North Tees Hospital to integrate HPB patient care. We share our experience of this novel One Stop clinic in a DGH setting. <h3>Methods</h3> We carried out a retrospective audit of all patients who attended the One Stop HPB clinic between Jan to Dec, 2021. Data collected included patient demographics, diagnosis and management. For the purpose of our audit, we classified HPB patients into 3 categories. Group 1 (Pancreatitis), Group 2 (HPB cancers) and Group 3 (All other benign HPB conditions). The aim was to assess the impact of streamlined patient care in regards to compliance with NICE guidelines and locally agreed disease specific pathways (2). <h3>Results</h3> 200 HPB patients (Median Age = 61, M/F ratio = 0.9) were seen in One Stop HPB clinic. In Group 1 (n=105, 36% new and 64% follow ups) 100% and 88% of patients were reviewed by the consultant and dietician respectively in the One Stop Clinic. 86% of patients with chronic pancreatitis had HbA1c checked of which 23% were diagnosed with Diabetes. Data was not captured appropriately with regards to Alcohol and Smoking cessation advice. Out of 38 new patients 10 (26%) and 8 (21%) of patients were referred to smoking and alcohol cessation In Group 2 (n=31, 95% new and 5% follow ups) 100%, 96% and 100% of all new patients with a diagnosis of HPB malignancy were reviewed jointly by the consultant, dietician and specialist nurse respectively In Group 3 (n= 64, 51% new and 49% follow ups) all patients were seen by the HPB physician. <h3>Conclusions</h3> Our audit shows that One Stop HPB clinic model can be implemented to streamline HPB patient care in a DGH setting. The One Stop clinic model functions well as a bridging clinic for the initial medical management of patients with newly diagnosed HPB cancers. <h3>References</h3> Hart AR, Johnson G, Huggett MT. Progressing pancreaticobiliary medicine in the UK. Frontline Gastroenterology 2019;10:206-207. NICE guideline [NG104] Pancreatitis