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Poor diagnosis and treatment mean repeat admissions for acute pancreatitis

Patients getting a raw deal, reveals first national audit of its kind

Caroline White

Thursday, 07 July 2016

Patients with acute pancreatitis all too often end up being readmitted to hospital, simply because doctors have failed to diagnose or properly treat the cause of their condition, finds the latest report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD).

Acute Pancreatitis: Treat the Cause is the first large scale assessment of the quality of care given to patients suffering with acute pancreatitis that has ever been carried out in the UK.

In one in five cases (143/692), the patient had had one or more previous episodes of acute pancreatitis, and in most (93%) of these, the cause of readmission was the same as it had been before.

In just one six month period in 2014, 14,000 people were admitted to hospital with the condition. The most common cause was gallstones (46.5%), followed by excess alcohol for 22%, the NCEPOD found. But in 17.5% (121) of cases, no underlying cause of the acute pancreatitis had been identified.

Only 19% (61/322) patients with acute pancreatitis caused by gallstones had surgery to remove them/their gallbladder during their admission. NCEPOD reviewers stated that 37% (53/143) of 179 patients who did not undergo early surgery (definitive treatment) should have done so, because this would have prevented further episodes.

And only half (51%; 28/52) of those reviewed whose condition was associated with heavy drinking were referred to an alcohol liaison service, despite 80% of hospitals in the study having onsite services.

“The majority of patients are admitted to hospital with gallstones, and the failure to clear them completely results in unacceptable rates of readmission with recurrent pancreatitis and other gallstone-related complications,” warned report co-author and NCEPOD Clinical Co-ordinator, Derek O'Reilly.

“Repeat hospital stays would be reduced significantly if patients with mild acute pancreatitis had surgery to remove gallstones within two weeks of admission,” he insisted.

Although the initial assessment was deemed prompt most patients it did not include any form of early warning score in 30.7% (154/502) of emergency department admissions for acute pancreatitis. In around a fifth of cases, patients will develop a potentially fatal very severe form of the condition, requiring critical care and a lengthy stint in hospital.

In one fifth (21%; 44/209) of patients no reason was given for not performing an ultrasound scan, and in a further fifth of cases the use of antibiotics was not considered appropriate.

“We have to avoid inappropriate antibiotic prescription, and our report found that 20% of the patients in the study had been given antibiotics unnecessarily. It is ineffective in the early stages, encourages the growth of resistant strains of bacteria, and wastes NHS resources,” pointed out O’Reilly.

Only a quarter (28/114) of hospitals without out-of-hours access to radiological drainage stated that they were part of a formal network to provide this care. The remainder said that they relied on “informal networks” and “local goodwill”. Fourteen hospitals said they had no arrangements in place for this intervention

And only around a third of hospitals in the current study reported being part of a formal regional care network for acute pancreatitis. These are important, says the report, because of the increasing complexity of the management of acute pancreatitis and its multidisciplinary nature: every patient should have access to specialist interventions, regardless of which hospital they present to.

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