Closing the audit loop is necessary to achieve compliance with evidence-based guidelines in the management of acute pancreatitis.
OBJECTIVE
The aim of this study was to assess the effect of the implementation of evidence-based guidelines and subsequent feedback to surgeons in the management of acute pancreatitis.


METHODS
An evidence-based Pancreatitis Proforma was developed. Data were prospectively recorded (01/06/2005-30/09/2007). Audit feedback (AFB) was performed at 9 months. A final analysis was performed comparing outcomes pre- and post-audit feedback.


RESULTS
372 patients were included. Median age (range) was 57 (12-96) years. 168 (45.2%) patients were admitted pre-AFB. Post-AFB, there was a significant increase in the number of patients whose diagnosis was made within 48 hours (135/168 (80.4%) vs 189/204 (92.6%), p<0.001) and who underwent definitive treatment for mild biliary pancreatitis (33/61 (54.1%) vs 56/70 (80.0%), p=0.002). Post-AFB there was also a significant reduction in the number of computed tomography (CT) scans performed for patients with mild acute pancreatitis (23/85 (27.1%) vs 13/99 (13.1%), p=0.018). Mortality (9/168 (5.4%) vs 3/204 (1.4%), p=0.040) also decreased. On multivariate analysis, AFB was an independent factor for change in the use of CT scans (p=0.015) and management of patients with mild biliary pancreatitis (p=0.039).


CONCLUSIONS
For evidence-based guidelines to be effective, feedback to surgeons is necessary.
Department of Surgery, Christchurch Hospital, PO Box 4345, Christchurch, New Zealand. saxon.connor@cdhb.govt.nz
Saxon J
SJ
Connor
Andrew R
AR
Lienert
Lisa A
LA
Brown
Philip F
PF
Bagshaw
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003625:Data Collection; D019317:Evidence-Based Medicine; D005246:Feedback; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000379:methods*; D008875:Middle Aged; D010195:Pancreatitis / Q000145:classification / Q000401:mortality / Q000601:surgery*; D012720:Severity of Illness Index