Impact of a clinical pathway on treatment outcome in patients with acute pancreatitis.
OBJECTIVE
To determine the impact of a clinical pathway (CP) on acute pancreatitis (AP) treatment outcome.


METHODS
A retrospective analysis of medical records was performed. We compared the results of AP treatment outcome over two time periods in our centre, before (2006-2007) and after (2010-2012) the implementation of a CP. The CP comprised the following indicators of quality: performance of all laboratory tests on admission (including lipids and carbohydrate deficient transferrin), determination of AP aetiology, abdomen ultrasound (US) within the first 24 h after admission, contrast-enhanced computed tomography of the abdomen in all cases of suspected pancreatic necrosis, appropriately selected and sufficiently used antibiotic therapy (if necessary), pain control, adequate hydration, control of haemodynamic parameters and transfer to the Intensive Care Unit (ICU) (if necessary), endoscopic retrograde cholangiopancreatography (ERCP) in biliary AP, surgical treatment (if necessary), and advice on outpatient follow-up after discharge. A comparison of the length of stay with that in other Slovenian hospitals was also performed.


RESULTS
There were 139 patients treated in the three-year period after the introduction of a CP, of which 81 (58.3%) were male and 58 (41.7%) female. The patients' mean age was 59.6 ± 17.3 years. The most common aetiologies were alcoholism and gallstones (38.8% each), followed by unexplained (11.5%), drug-induced, hypertriglyceridemia, post ERCP (2.9% each) and tumours (2.2%). Antibiotic therapy was prescribed in 72 (51.8%) patients. Abdominal US was performed in all patients within the first 24 h after admission. Thirty-two (23.0%) patients were treated in the ICU. Four patients died (2.9%). In comparison to 2006-2007, we found an increased number of alcoholic and biliary AP and an associated decrease in the number of unexplained aetiology cases. The use of antibiotics also significantly decreased after the implementation of a CP (from 70.3% to 51.8%; P = 0.003). There was no statistically significant difference in mortality (1.8% vs 2.9%). The length of stay was significantly shorter when compared to the Slovenian average (P = 0.018).


CONCLUSIONS
The introduction of a CP has improved the treatment of patients with AP, as assessed by all of the observed parameters.
Miroslav Vujasinovic, Jana Makuc, Apolon Marolt, Zdenko Kikec, Nace Robac, Department of Internal Medicine, General Hospital Slovenj Gradec, 2380 Slovenj Gradec, Slovenia.
Miroslav
M
Vujasinovic
Miroslav Vujasinovic, Jana Makuc, Apolon Marolt, Zdenko Kikec, Nace Robac, Department of Internal Medicine, General Hospital Slovenj Gradec, 2380 Slovenj Gradec, Slovenia.
Jana
J
Makuc
Miroslav Vujasinovic, Jana Makuc, Apolon Marolt, Zdenko Kikec, Nace Robac, Department of Internal Medicine, General Hospital Slovenj Gradec, 2380 Slovenj Gradec, Slovenia.
Bojan
B
Tepes
Miroslav Vujasinovic, Jana Makuc, Apolon Marolt, Zdenko Kikec, Nace Robac, Department of Internal Medicine, General Hospital Slovenj Gradec, 2380 Slovenj Gradec, Slovenia.
Apolon
A
Marolt
Miroslav Vujasinovic, Jana Makuc, Apolon Marolt, Zdenko Kikec, Nace Robac, Department of Internal Medicine, General Hospital Slovenj Gradec, 2380 Slovenj Gradec, Slovenia.
Zdenko
Z
Kikec
Miroslav Vujasinovic, Jana Makuc, Apolon Marolt, Zdenko Kikec, Nace Robac, Department of Internal Medicine, General Hospital Slovenj Gradec, 2380 Slovenj Gradec, Slovenia.
Nace
N
Robac
D000208:Acute Disease; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D019091:Critical Pathways; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D017524:Slovenia; D013997:Time Factors; D016896:Treatment Outcome
Acute; Clinical pathway; Indicator; Pancreatitis; Quality; Treatment