Annual Scientific Meeting
Introduction: The management of acute pancreatitis has evolved over the last decade with emphasis on early adequate fluid resuscitation, early nutrition, and cholecystectomy prior to hospital discharge in gallstone pancreatitis. Adherence to these metrics reduces mortality, hospital length of stay (LOS), and overall healthcare utilization. We evaluated our institution’s current performance and subsequently devised a strategy to improve adherence to quality metrics.
Methods: Patients hospitalized with acute pancreatitis between January, 2017 and October, 2018 were reviewed. Patient demographics, etiology and severity of pancreatitis, rate and type of IV fluid resuscitation, time to initiating nutrition, hospital LOS, ICU LOS, and hospital re-admission rates were examined. An EMR order set for inpatient management of acute pancreatitis was then designed and launched in December, 2018. Follow up data was collected until May, 2019.
Results: Our baseline data included 240 hospitalizations for acute pancreatitis of varying etiologies (Figure 1) and severity (Figure 2). The average patient age was 54.3 years and the average BMI was 28.3 (Figure 3). The mean hospital LOS was 6 days. ICU care was needed in 17% of cases. Mean ICU LOS was 4 days. The 30-day hospital re-admission rate was 14%. Adequate IV fluid resuscitation was given in only 25% of cases, with 20% receiving Lactated Ringer’s (LR) solution. The average time to starting nutrition was 3 days. Cholecystectomy was performed prior to hospital discharge in 87% of mild gallstone pancreatitis cases. After launch, the EMR order set was used in 19 of 70 hospitalizations for acute pancreatitis (usage rate 27%). Among these patients, 79% received adequate fluid resuscitation, with 84% receiving LR. The average time to starting nutrition was 1.4 days. The mean hospital LOS was 4.4 days. No patients required ICU level care.
Discussion: Our baseline data revealed non-adherence to guideline recommendations of adequate fluid resuscitation with LR and early enteral feeding. By designing a customized EMR order set, we improved adequate fluid resuscitation from 25% to 79%, while reducing time to nutrition from 3 days to 1.4 days. Our average hospital LOS decreased from 6 days to 4.4 days, below the national average of 4.7 days. The advent of our EMR order set for acute pancreatitis has helped standardize management and improve outcomes thus far. Further work is needed to increase EMR order set utilization and continue data collection on patient outcomes.