TU8.13 How can we help things move along? – A review of the management of the acute bowel obstruction

Abstract

Abstract Background Acute bowel obstruction (ABO) is a common surgical emergency and is associated with significant morbidity and mortality. Currently there is no national guidance for the management of ABO and an NCEPOD study highlighted the resulting variance in care nationwide. This study recommended several standards of care for the management of ABO and we aimed to review our practice against this guidance. Method A retrospective review identified all adult patients admitted with a radiologically confirmed diagnosis of ABO, over an 8 month period. 8 key performance indicators (KPIs) were adapted from the NCEPOD recommendations and data was collected from patient notes, drug charts and computer records. A total of 22 patients are included in this study to date. Results The median length of time from referral to surgical review and from surgical review to CT scan was 112 mins and 134 mins respectively. 31.8% of patients underwent emergency surgery. Pain documentation was the only KPI that met 100% target compliance. A MUST score was completed in 72.7% of cases, a treatment escalation plan in 36.4% of cases, hydration status was documented in 4.5% of cases and no patients had a frailty score documented. Conclusion Our results demonstrate that significant improvements can be made in the management of ABO and the recognition of aspects known to impact patient morbidity and mortality. In keeping with NCEPOD recommendations we suggest the implementation of an ABO pathway. We hope this will assist clinicians in caring for patients with ABO, promote MDT collaboration and highlight clinical concerns early.