title: Improving the management of spontaneous bacterial peritonitis in cirrhotic patients: assessment of an intervention in trainee doctors.
abstract: Spontaneous bacterial peritonitis (SBP) in cirrhotic patients is a serious complication associated with a high mortality rate. A baseline audit of the acute medical take (AMT) at Northwick Park suggested a lack of awareness regarding management. A questionnaire based on contemporary SBP guidelines was circulated to all trainee doctors (FY1 to SpR). Ascitic fluid testing requests were analysed over a six-month period. The electronic requesting system was updated to include prompts and direct links to Trust SBP guidelines, and a one-hour lecture to all members of the AMT, supported by an educational booklet on SBP, was performed. Re-audit was carried out six months post-intervention, the AMT completed a second questionnaire and ascitic fluid testing requests were re-audited. In comparable pre- and post-intervention AMT cohorts, a clinical and educational intervention led to a significant improvement in understanding of when to investigate (p≤0.001), samples (p = 0.002) and containers (p≤0.001) required, urgency of obtaining results (p≤0.001), and initiation of treatment for suspected SBP (p = 0.007). Significantly more ascitic samples were sent, with specific suspicion of SBP more readily documented, crucial to expediting laboratory processing. Targeted education and production of a clinical algorithm has significantly improved the management of patients with SBP.
authors.affiliation: Northwick Park Hospital, Harrow, UK tmr07@ic.ac.uk.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Rawson
authors.affiliation: Northwick Park Hospital, Harrow, UK.
authors.forename: Sonia
authors.initials: S
authors.lastname: Bouri
authors.affiliation: Northwick Park Hospital, Harrow, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Allen
authors.affiliation: Northwick Park Hospital, Harrow, UK.
authors.forename: João
authors.initials: J
authors.lastname: Ferreira-Martins
authors.affiliation: Northwick Park Hospital, Harrow, UK.
authors.forename: Abulkani
authors.initials: A
authors.lastname: Yusuf
authors.affiliation: Northwick Park Hospital, Harrow, UK.
authors.forename: Nina
authors.initials: N
authors.lastname: Stafford
authors.affiliation: Northwick Park Hospital, Harrow, UK.
authors.forename: Maxton
authors.initials: M
authors.lastname: Pitcher
authors.affiliation: Northwick Park Hospital, Harrow, UK.
authors.forename: Meron
authors.initials: M
authors.lastname: Jacyna
mesh_terms: D001424:Bacterial Infections / Q000175:diagnosis / Q000628:therapy*; D004502:Education, Medical, Continuing; D006801:Humans; D007318:Inservice Training / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications*; D010538:Peritonitis / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires
keywords: Spontaneous bacterial peritonitis; clinical audit; diagnostics; educational intervention; guidelines; infection management