Nicholas R. Ludvik, MD, Lauren Loeb, BS, Yazan Fahmawi, MD, Gabriel Bolanos-Guzman, MD, Abrahim Hanjar, MD, Jessica Houston, DO, Kyle Humphrey, MD, Michael Lysek, MD, Gilad Shapira, DO, Meir Mizrahi, MD; University of South Alabama, Mobile, AL
Introduction: As of 2016, acute pancreatitis(AP) was responsible for $2.5 billion in health care costs (NEJM). It is among the most common gastrointestinal reasons for hospitalization and incidence is increasing (NEJM). Consequently, its management represents a prime target for optimization of quality of care to minimize unnecessary spending. Methods: IRB approval obtained. Patient data from October 1, 2017 to April 30, 2019, obtained for patients with international classification of disease codes for pancreatitis, includingchronic and acute. Variables studied included publishedguideline metrics for quality of pancreatitis care. Grand rounds presentation was delivered to internal medicine department in which institutional performance was integrated into guideline review. Knowledge acquisition assessed with survey before and after lecture. Patient data was collected again beginning from date of presentation. Results: Pre-intervention data yielded pool of 772 patients with 1118 encounters. Patients not admitted or without pancreatitis excluded, yielding 239 patients over 316 encounters. Survey data from grand rounds indicated significant improvement in participant score regarding ordering ultrasoundnot CT to assess for biliary etiology(p=5.61x10^-10), promoting early enteral feeding (p=4.22x10-6), prescribing low fat diet (p=0.05), and performing cholecystectomy prior to discharge for gallstone pancreatitis (p=0.003). Performance data review indicatessignificantly decreased time to feed (p=0.04, from mean 28 to 17 hours, standard deviation (SD)7.78). Values not reaching significance but showing considerable trending towards improvement include: decreasing lipase draws (p=0.36, mean decreased 1.97 to 1.58, SD 0.28), length of stay (p=0.44, mean decreased from 155.5 to 103.7 hours, SD36.63), cholecystectomy prior to discharge (p=0.94, mean increased from 0.58 to 1, SD 0.30), and follow up with gastroenterology (p=0.06, mean increased from 0.18 to 0.5, SD 0.23). Discussion: Data collected thus far indicates improvement in both knowledge and performance in several quality metrics. Further study is needed to further validate our findings, particularly in the acquisition of further post intervention data as there was a considerable decrease in the number of patients admitted to our institution for pancreatitis since the advent of COVID 19. Data thus far appears to indicate that a low cost intervention can be utilized to promote increased awareness and possibly effect better care at reduced cost.
Disclosures: Nicholas Ludvik indicated no relevant financial relationships. Lauren Loeb indicated no relevant financial relationships. Yazan Fahmawi indicated no relevant financial relationships. Gabriel Bolanos-Guzman indicated no relevant financial relationships. Abrahim Hanjar indicated no relevant financial relationships. Jessica Houston indicated no relevant financial relationships. Kyle Humphrey indicated no relevant financial relationships. Michael Lysek indicated no relevant financial relationships. Gilad Shapira indicated no relevant financial relationships. Meir Mizrahi indicated no relevant financial relationships.