title: Compliance with Evidence-Based Guidelines in Acute Pancreatitis: an Audit of Practices in University of Toronto Hospitals.
abstract: Despite existing evidence-based practice guidelines for the management of acute pancreatitis, clinical compliance with recommendations is poor. We conducted a retrospective review of 248 patients admitted between 2010 and 2012 with acute pancreatitis at eight University of Toronto affiliated hospitals. We included all patients admitted to ICU (52) and 25 ward patients from each site (196). Management was compared with the most current evidence used in the Best Practice in General Surgery Management of Acute Pancreatitis Guideline. Fifty-six patients (22.6 %) had only serum lipase tested for biochemical diagnosis. Admission ultrasound was performed in 174 (70.2 %) patients, with 69 (27.8 %) undergoing ultrasound and CT. Of non-ICU patients, 158 (80.6 %) were maintained nil per os, and only 18 (34.6 %) ICU patients received enteral nutrition, commencing an average 7.5 days post-admission. Fifty (25.5 %) non-ICU patients and 25 (48.1 %) ICU patients received prophylactic antibiotics. Only 24 patients (22.6 %) with gallstone pancreatitis underwent index admission cholecystectomy. ERCP with sphincterotomy was under-utilized among patients with biliary obstruction (16 [31 %]) and candidates for prophylactic sphincterotomy (18 [22 %]). Discrepancies exist between the most current evidence and clinical practice within the University of Toronto hospitals. A guideline, knowledge translation strategy, and assessment of barriers to clinical uptake are required to change current clinical practice.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: J A
authors.initials: JA
authors.lastname: Greenberg
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Hsu
authors.affiliation: Department of Surgery, University of Toronto, Toronto, ON, Canada.|Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Bawazeer
authors.affiliation: Department of General Surgery, St. Michael's Hospital, Toronto, ON, Canada.|Critical Care Medicine, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Marshall
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada.|Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.|Critical Care Medicine, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: J O
authors.initials: JO
authors.lastname: Friedrich
authors.affiliation: Department of Surgery, University of Toronto, Toronto, ON, Canada.|Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Nathens
authors.affiliation: Department of Surgery, University of Toronto, Toronto, ON, Canada.|Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Coburn
authors.affiliation: Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Surgery, University of Toronto, Toronto, ON, Canada. robin.mcleod@cancercare.on.ca.|Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. robin.mcleod@cancercare.on.ca.|Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada. robin.mcleod@cancercare.on.ca.|Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada. robin.mcleod@cancercare.on.ca.|Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON, Canada. robin.mcleod@cancercare.on.ca.
authors.forename: R S
authors.initials: RS
authors.lastname: McLeod
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D002763:Cholecystectomy; D002779:Cholestasis / Q000601:surgery; D004750:Enteral Nutrition; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis* / Q000601:surgery*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D055815:Young Adult
keywords: Evidence-based practice; Guideline adherence; Pancreatitis; Practice guidelines as topic; Professional practice