Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2015; 21(30): 9150-9155
Published online Aug 14, 2015. doi: 10.3748/wjg.v21.i30.9150
Impact of a clinical pathway on treatment outcome in patients with acute pancreatitis
Miroslav Vujasinovic, Jana Makuc, Bojan Tepes, Apolon Marolt, Zdenko Kikec, Nace Robac
Miroslav Vujasinovic, Jana Makuc, Apolon Marolt, Zdenko Kikec, Nace Robac, Department of Internal Medicine, General Hospital Slovenj Gradec, 2380 Slovenj Gradec, Slovenia
Bojan Tepes, Abakus Medico Diagnostic Centre Rogaska, Prvomajska 29a, 3250 Rogaska Slatina, Slovenia
Author contributions: Vujasinovic M and Makuc J designed the study and drafted the manuscript; Vujasinovic M, Makuc J, Marolt A, Kikec Z and Robac N collected the data; Vujasinovic M, Makuc J and Tepes B wrote the manuscript.
Institutional review board statement: The analysis of medical records was approved by the General Hospital Slovenj Gradec ethics committee.
Conflict-of-interest statement: The authors declare no conflict of interest regarding this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Miroslav Vujasinovic, MD, MSc, Department of Internal Medicine, General Hospital Slovenj Gradec, Gosposvetska 1, 2380 Slovenj Gradec, Slovenia. mvujas@gmail.com
Telephone: +386-2-8823400 Fax: +386-2-8823505
Received: January 18, 2015
Peer-review started: January 30, 2015
First decision: April 13, 2015
Revised: April 23, 2015
Accepted: June 15, 2015
Article in press: June 16, 2015
Published online: August 14, 2015
Abstract

AIM: 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).

CONCLUSION: The introduction of a CP has improved the treatment of patients with AP, as assessed by all of the observed parameters.

Keywords: Acute, Pancreatitis, Treatment, Clinical pathway, Indicator, Quality

Core tip: We wanted to improve the quality and streamline the process of treatment in patients with acute pancreatitis (AP) by introducing a clinical pathway (CP) and control of indicators of quality (IOQ). Our results showed that the use of a CP and control of IOQ improved the treatment of patients with AP, as assessed by the following observed parameters: reduced length of stay, reduced percentage of unexplained aetiology cases and reduced use of antibiotic therapy (without changes in total mortality).