title: Clinical audit: recent practice in caring for patients with acute severe colitis compared with published guidelines--is there a problem?
abstract: BACKGROUND
  Acute severe colitis (ASC) is a serious condition with possible outcomes of emergency colectomy and mortality. Validated guidelines exist to help avoid these.
  
  
  OBJECTIVE
  To examine local adherence to guidelines and identify (a) opportunities to improve care and (b) possible barriers to adherence.
  
  
  METHODS
  Retrospective, hospital-wide audit of all patients with ASC during a 2-year period (2009-2010) at a major metropolitan hospital. Cases were identified by an electronic search of all discharges with International Classification of Diseases-10 codes for colitis, colectomy, ulcerative colitis or Crohn disease.
  
  
  RESULTS
  Twenty-six patients had 30 ASC admissions (14 female). Most admissions were under gastroenterology (25), 4 (13%) were under general medicine and 1 was under general surgery. Only 8 patients' (26%) management (all under gastroenterology) included all major details: blood investigations, Clostridium difficile test, abdominal X-ray, colonic examination and venous thromboembolism prophylaxis. Only one patient had formal severity scoring on admission, and seven patients (24%) had descriptive severity recorded. On day 3, nine patients (30%) had some recorded severity assessment; however, no formal criteria were used. Four had colectomy, three during first admission and one on re-admission. Of these patients, three received cyclosporine prior to colectomy. The mean duration of admission was 10 days (standard deviation 10.54, range 1-61).
  
  
  CONCLUSIONS
  Opportunities to optimise care exist including formal severity assessments on days 1 and 3, better deep vein thrombosis/pulmonary embolism prophylaxis and prompt colonic examination. Admission under teams other than gastroenterology appeared to be a barrier to better care. Despite the low rate of ideal management, the colectomy rate was acceptably low at 20%.
authors.affiliation: University of Adelaide, Adelaide, South Australia, Australia. amanda.h.lim@student.adelaide.edu.au
authors.forename: A H
authors.initials: AH
authors.lastname: Lim
authors.forename: R
authors.initials: R
authors.lastname: Grafton
authors.forename: D J
authors.initials: DJ
authors.lastname: Hetzel
authors.forename: J M
authors.initials: JM
authors.lastname: Andrews
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003092:Colitis / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D005791:Patient Care / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult