P0908 - Acute Pancreatitis Management Discrepancies Between Different Services in a Single Hospital Setting Affecting Patient Outcomes

Presenting Author(s)

• 

  Nabeeha Mohy-ud-din, MD

  Pittsburgh, Pennsylvania

Nabeeha Mohy-ud-din, MD, Ivana Deyl, MD, Shifa Umar, MD, Heitham Abdul Baki, MD, Suzanne Morrissey, MD

Allegheny Health Network, Pittsburgh, PA

Introduction: In the US, acute pancreatitis (AP) is a leading cause of inpatient care among Gl conditions at an aggregate cost of >$2.6 billion per year. Multiple clinical guidelines exist for AP, however institutional practices vary in adherence to these. Our study compares the management of AP and adherence to published guidelines among teaching and non-teaching medicine services within the same center. Survey-based methods of analysis were performed.

Methods: A retrospective chart review of patients with an unplanned admission to a non-ICU hospital ward between Jan 2016-Jan 2017 with primary diagnosis of AP was performed. ICU admissions and hospital transfers were excluded. Clinical and epidemiological data was extracted, and patients were stratified to their respective admitting services: academic teaching medical service and non-teaching hospitalist service. Mean fluid resuscitation was defined as fluids ordered for patient for the first 24-48 hours. 

Results: A total of 75 patients were included in the study. 37% (n=28) were admitted to a resident teaching service (TS) and 63% (n=47) to a hospitalist non-teaching service (NTS). Baseline characteristics between the two groups were comparable with similar age, sex, etiology of pancreatitis and BISAP scores (Table 1). The most common cause of acute pancreatitis on the TS and NTS were alcohol induced (35.7%, n=10) and gallstone pancreatitis (42.5%, n=20), respectively. 96% of patients (n=27) admitted to a TS and 25% (n=12) on NTS had CRP ordered on admission (p=< 0.001). Lactated Ringers was ordered for 68% (n=19) and 21% (n=10) of patients on TS and NTS (p=< 0.001), respectively. Mean fluid resuscitation for patients admitted to TS was 153 +/- 45 ml/hr compared to 113 +/- 43 ml/hr for NTS (p=< 0.001). A Gastroenterology consult was placed for 43% (n=12) of patients admitted to TS and 75% (n=35) of NTS (p=0.008). Length of stay was comparable at 4.85 +/- 6.2 and 4.53 +/- 4.9 days for TS and NTS, respectively. Details of differences in management between both services are summarized in Table 2.

Discussion: Wide variability exists in management of patients admitted to different services within the same institution. Significant differences exist in labs ordered, type of fluid ordered on admission, rate of fluid and consultations to the GI team. We aim to target these differences through a multi-faceted quality improvement initiative.

Disclosures:

Citation: Nabeeha Mohy-ud-din, MD, Ivana Deyl, MD, Shifa Umar, MD, Heitham Abdul Baki, MD, Suzanne Morrissey, MD. P0908 - ACUTE PANCREATITIS MANAGEMENT DISCREPANCIES BETWEEN DIFFERENT SERVICES IN A SINGLE HOSPITAL SETTING AFFECTING PATIENT OUTCOMES. Program No. P0908. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.