An Audit to Evaluate the Prevalence and Efficiency of the 'Acute Abdomen Pathway' Proforma Used in a Large District General Hospital.

Published Date: 30th August 2023

Publication Authors: Ross M, Kalaiselvan R, Yasin U, Gul A

Abstract

The 'acute abdomen pathway' was introduced with the aim of early identification of patients with an acute abdomen and once identified to increase the efficiency of imaging, senior review and if required surgical intervention. We audited how this pathway was being used by clerking doctors and its benefits to patient care.

Method

Data collection occurred over 4 weeks (11/09/22-9/10/22) giving a cohort of 390 patients. Patients who met the criteria for 'acute abdomen' were included in the study (e.g. high clinical suspicion of acute abdomen, NEWS2 score >4, recent abdominal surgery, pain score >5/10, history of abdominal trauma, signs of sepsis). We reported time from triage to: surgical review, CT, diagnosis and management.
 

Result

112 patients met the criterion for the acute abdomen pathway. 4 were correctly recognised and diagnoses included appendicitis, perforated diverticulitis, obstructive cholangitis and complication post-laparotomy. 108 patients were not started on the pathway, their diagnoses included appendicitis (19), pancreatitis (7), small bowel obstruction (5) and others. Waiting times reduced whilst using the proforma. Time from CT request to report fell to 5 hours (from 14). Similarly, triage to diagnosis fell to 5 hours (from 12) and to management 5 hours (from 13).

Conclusion

 The acute abdomen pathway is not being used as intended by clerking doctors. The criteria highlighted 112 patients, of which, 65 (58%) received a diagnosis under the umbrella of an 'acute abdomen'. Our plan is to re-audit once more awareness has been raised to reassess compliance and hopefully show reduction in time from diagnosis to intervention.

 

Ross, M; Gul, A; Kalaiselvan, R; Yasin U. (2023). An Audit to Evaluate the Prevalence and Efficiency of the 'Acute Abdomen Pathway' Proforma Used in a Large District General Hospital. British Journal of Surgery. 110(Suppl 7). [Online]. Available at: https://dx.doi.org/10.1093/bjs/znad258.126 [Accessed 5 January 2024].

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