title: Impact of a care pathway in acute pancreatitis.
abstract: BACKGROUND
  Previous studies have shown that accurate process of care predicts quality of care. Few examples currently exist for process of care for the acute surgical patient. A recent region wide audit had identified good outcomes for patients with acute pancreatitis at our institution but aspects of care that could be improved.
  
  
  METHODS
  For this re-audit, a simple written care pathway for the management of those presenting with acute pancreatitis was introduced in our institution from February to July 2009. The audit standards were set against the British Society of Gastroenterology (BSG) guidelines for management of acute pancreatitis and were compared with the previous region wide audit.
  
  
  RESULTS
  Marked improvements were noted in the rates of abdominal imaging achieved within 24 h of diagnosis (35.2% vs 47.7%), severity stratification within 48 h of diagnosis (28.7% vs 75%), critical care admission for those classified as severe (39.3% vs 63.6%) and definitive treatment during index admission (22.2% vs 38.5%). Survival rates were 100% for this audit cycle and 95% for all patients within the region wide audit. Despite these improvements, care still does not reach the standards set out by BSG.
  
  
  CONCLUSIONS
  Predefined processes of care may help to recognise those developing or likely to develop severe pancreatitis, ensure accurate documentation of severity, expedite critical care review and/or admission, and help to encourage the timely management of those with a treatable underlying cause of their pancreatitis.
authors.affiliation: Education Centre, North Tyneside General Hospital, Rake Lane, North Shields NE29 8NH, UK. iainmccallum@nhs.net
authors.forename: Iain J D
authors.initials: IJ
authors.lastname: McCallum
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Hicks
authors.forename: Stephen
authors.initials: S
authors.lastname: Attwood
authors.forename: Keith
authors.initials: K
authors.lastname: Seymour
mesh_terms: D000208:Acute Disease; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003422:Critical Care / Q000706:statistics & numerical data; D019091:Critical Pathways / Q000458:organization & administration*; D004739:England; D042882:Gallstones / Q000150:complications / Q000601:surgery; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008485:Medical Audit; D010195:Pancreatitis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D010343:Patient Admission / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data