Tu1137 ADHERENCE WITH THE 2019 QUALITY INDICATORS FOR ACUTE PANCREATITIS MANAGEMENT: IS THERE A DIFFERENCE BETWEEN MEDICINE AND SURGERY SERVICES?

Abstract

The management of acute pancreatitis can be challenging for admitting hospital services, as multiple guidelines, recommendations, and scoring systems are available for management. In 2019, the Acute Pancreatitis Task Force on Quality published 40 quality indicators intended for providers to use to ensure the delivery of high-quality and evidence-based care to patients with acute pancreatitis. In this study, we aimed to 1) determine if these indicators can be used to evaluate performance in management of acute pancreatitis 2) evaluate the real-world adherence with these recommendations and 3) compare adherence to these indicators between the two major admitting services. This was a quality improvement initiative at a tertiary care academic medical center. A retrospective chart review of patients admitted with acute pancreatitis was performed. Patient characteristics and data relevant to the quality indicators were compiled. Adherence with the quality indicators individually and with the overarching domains was calculated and compared between admitting services. Data was obtained from 331 patients who were admitted between 1/2018 and 12/2018 and had a primary admitting diagnosis of acute pancreatitis. 27/40 (67.5%) individual quality indicators could be assessed, including at least 1 indicator from each of the 10 domains (Diagnosis, Etiology, Initial Assessment/Risk Stratification, Initial Management, ERCP, Nutrition, Pharmacotherapy, Management of Early Complications, Surgery, and Structure of Care). The average overall adherence with each quality indicator was 80.4% regardless of service. When analyzed by admitting service, the overall adherence by the medicine service was higher than by the surgery service (91.5% vs. 80.8%, p<0.01). When subdivided into domain, medicine compliance was significantly higher for Etiology (91.0% vs. 82.9%, p<0.01), which included quality indicators involving obtaining relevant medical histories and confirmatory labwork, and Pharmacotherapy (90.1% vs. 74.3%, p<0.01), which included quality indicators about judicious antibiotic administration. Meanwhile, surgery had significantly higher compliances in Initial Management (69.3% vs. 60.3%, p<0.01), which included appropriate administration and documentation of fluid resuscitation, and Surgery (95.5% vs. 81.5%, p=0.04), which involved relevant surgical management of pancreatitis and its complications. These quality indicators can be used to monitor management of acute pancreatitis. In our cohort both medicine and surgical services had overall high adherence to the Task Force’s quality indicators. Strengths of each service were different and apparent when evaluating adherence by domain. Separate interventions to improve adherence should be delivered to each service to target their particular areas for improvement.