MedStar Georgetown University Hospital Washington, DC
Bryan S. Stone, DO1, Wei Yan, MD1, Cory Higley, DO, MPH1, Andrew Stevens, MD1, Shandiz Shahbazi, MD1, Ilan Vavilin, MD1, Albert C. Shu, MD1, Rabin Neupane, MBBS2, Disha Sharma, MBBS2, Nadim G. Haddad, MD3, Sandeep Nadella, MBBS1; 1MedStar Georgetown University Hospital, Washington, DC; 2MedStar Washington Hospital Center, Washington, DC; 3MedStar Georgetown University Hospital, Potomac, MD
Introduction: Acute pancreatitis (AP) is an inflammatory process of the pancreas and one of the most common gastrointestinal illnesses of hospitalized patients. It is a cause of significant morbidity and financial burden. Errors in the process of diagnosing AP can lead to delays in patient care and unnecessary health care expenditures. We compared the trends of diagnosis and adherence to guidelines between tertiary care (TC) and non-tertiary care (NTC) hospitals within a ten hospital system spanning across Maryland and District of Columbia. Methods: Records from two TC hospitals and eight NTC hospitals from March 2015 – June 2019 were queried for ICD-10 codes of acute pancreatitis. 4000 patients were identified, of which 2,541 had complete and extractable data. Manual review of charts yielded 1903 encounters as satisfying Revised Atlanta Classification (RAC). We collected and analyzed etiology, laboratory tests, imaging, treatment variables and other diagnostic studies, which we then contrasted between tertiary care and non-tertiary care hospitals. Results: We identified a total of 2,541 patients, 845 of whom underwent care at a TC hospital and 1696 patients who presented at a NTC hospital. Those who met the RAC at TC and NTC accounted for 75.9% and 74.4% of patients, respectively (p = 0.43). At TC hospitals, although 60.6% of patients satisfied RAC with classic epigastric pain and elevated lipase, 90.8% of these patients still underwent an imaging study. At NTC hospitals, 58.3% had pancreatic-type pain and elevated lipase, of which 90.4% of those patients underwent an imaging study. CT/MRI with contrast was the most common imaging modality at both TC (56.8%) and NTC hospitals (68.1%) of which the sensitivities for AP at TC and NTC were 59.6% and 56.0%, respectively. There was no significant difference in the proportion of patients who had documentation of their workup between TC and NTC (p = 0.41) Discussion: The proportion of patients who received imaging despite meeting clinical criteria were not significantly different between our TC and NTC hospitals. However, a higher utilization of CT/MRI with contrast was observed in NTC hospitals, which was statistically significant. Given the time burden, cost and potential delay in treatment in obtaining unnecessary imaging, we have identified one area for targeted interventions to reduce redundancies in AP workup, and thus improve adherence to AP guidelines across our large healthcare organization.
Disclosures: Bryan Stone indicated no relevant financial relationships. Wei Yan indicated no relevant financial relationships. Cory Higley indicated no relevant financial relationships. Andrew Stevens indicated no relevant financial relationships. Shandiz Shahbazi indicated no relevant financial relationships. Ilan Vavilin indicated no relevant financial relationships. Albert Shu indicated no relevant financial relationships. Rabin Neupane indicated no relevant financial relationships. Disha Sharma indicated no relevant financial relationships. Nadim Haddad indicated no relevant financial relationships. Sandeep Nadella indicated no relevant financial relationships.