P0024 - Transition from a Primary Gastroenterology Inpatient Service to a Consultative Model - Effects on Meeting Quality Indicators and Performance Threshold Targets for Acute Pancreatitis

Mark J. Radlinski, MD¹, William Bigelow, MD², Allen Luk, ³, Daniel Strand, MD^3
1University of Virginia Digestive Health Center, Charlottesville, VA; ²University of Virginia Health System, Charlottesville, VA; ³University of Virginia, Charlottesville, VA

Introduction: In July 2018, the UVA gastroenterology department transitioned from a primary inpatient service (staffed by gastroenterologists) to a consultative model with a primary team staffed by primarily hospitalists. In 2019, the ACG published a physician-led initiative that compiled forty quality indicators and performance threshold targets for the diagnosis and management of acute pancreatitis. These quality indicators and performance threshold targets provide a rubric by which we can evaluate performance metrics before and after the transition to a consultative model. To date, there has not been a published study on the effect of an inpatient gastroenterology service versus hospitalist primary team with gastroenterology consultation on meeting quality indicators for acute pancreatitis management. We performed a retrospective study in which these quality indicators are assessed for patients admitted with acute pancreatitis.

Methods: A total of 44 patients from 7/2017 – 6/2018 (admitted to a gastroenterology primary inpatient team) were compared to 48 patients from 7/2018 – 7/2019 (admitted to a non-gastroenterology primary inpatient team). Only patients with acute pancreatitis, presenting either through the emergency room or admitted directly from endoscopy were included (chronic pancreatitis and OSH transfers excluded from analysis). Quality metrics were retroactively measured for each group. A variety of additional metrics, including length of stay, readmission rates, volume resuscitation over the initial 24 hours, and decrease in hemoglobin and BUN over the first 24 hours.

Results: Average length of stay 5.77 days as compared to 6.16 days for the GI service as compared to the Medicine service. 30-day Readmission rate was 15.78% as opposed to 18.75% for the GI service as compared to the Medicine service. Net fluid total was. 1L more for the GI service as compared to the Medicine service. However, when comparing the number of quality indicators met by the GI primary service as compared to the medicine primary service, the medicine service was non-inferior (met 22 threshold targets as compared to 19).

Discussion: There does not appear to be a significant difference in the number of quality metrics achieved in care for patients with acute pancreatitis when comparing a gastroenterologist led service and a general medicine primary service. It should be noted that the GI team was still involved in a consultative role in many of these patients.

	Gastroenterology Primary Service	General Medicine Primary Service
# of Patients	44	48
Average Length of Stay (Days)	5.77	6.16
30 day Readmission Rate	15.78%	18.75%
Net Fluid Balance (0-24 hours)	+4.69L	+3.75L
Decrease in Hemoglobin after 24 hours	-1.68	-1.57

Disclosures:
Mark Radlinski indicated no relevant financial relationships.
William Bigelow indicated no relevant financial relationships.
Allen Luk indicated no relevant financial relationships.
Daniel Strand indicated no relevant financial relationships.


Mark J. Radlinski, MD¹, William Bigelow, MD², Allen Luk, ³, Daniel Strand, MD³. P0024 - Transition from a Primary Gastroenterology Inpatient Service to a Consultative Model - Effects on Meeting Quality Indicators and Performance Threshold Targets for Acute Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.