Kothari DJ, Sheth SG. Innovative pathways allow safe discharge of mild acute pancreatitis from the emergency room. World J Gastroenterol 2024; 30(11): 1475-1479 [PMID: 38617458 DOI: 10.3748/wjg.v30.i11.1475]
Corresponding Author of This Article
Sunil G Sheth, AGAF, FACG, FASGE, MBBS, MD, Associate Professor, Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, United States. ssheth@bidmc.harvard.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
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/
World J Gastroenterol. Mar 21, 2024; 30(11): 1475-1479 Published online Mar 21, 2024. doi: 10.3748/wjg.v30.i11.1475
Innovative pathways allow safe discharge of mild acute pancreatitis from the emergency room
Darshan J Kothari, Sunil G Sheth
Darshan J Kothari, Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States
Sunil G Sheth, Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
Author contributions: Kothari DJ and Sheth SG contributed equally to the manuscript; both the authors designed the study and write the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sunil G Sheth, AGAF, FACG, FASGE, MBBS, MD, Associate Professor, Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, United States. ssheth@bidmc.harvard.edu
Received: November 27, 2023 Peer-review started: November 27, 2023 First decision: January 5, 2024 Revised: January 22, 2024 Accepted: February 27, 2024 Article in press: February 27, 2024 Published online: March 21, 2024
Abstract
Acute pancreatitis (AP) is a leading cause of gastrointestinal-related hospitalizations in the United States, resulting in 300000 admissions per year with an estimated cost of over $2.6 billion annually. The severity of AP is determined by the presence of pancreatic complications and end-organ damage. While moderate/severe pancreatitis can be associated with significant morbidity and mortality, the majority of patients have a mild presentation with an uncomplicated course and mortality rate of less than 2%. Despite favorable outcomes, the majority of mild AP patients are admitted, contributing to healthcare cost and burden. In this Editorial we review the performance of an emergency department (ED) pathway for patients with mild AP at a tertiary care center with the goal of reducing hospitalizations, resource utilization, and costs after several years of implementation of the pathway. We discuss the clinical course and outcomes of mild AP patients enrolled in the pathway who were successfully discharged from the ED compared to those who were admitted to the hospital, and identify predictors of successful ED discharge to select patients who can potentially be triaged to the pathway. We conclude that by implementing innovative clinical pathways which are established and reproducible, selected AP patients can be safely discharged from the ED, reducing hospitalizations and healthcare costs, without compromising clinical outcomes. We also identify a subset of patients most likely to succeed in this pathway.
Core Tip: In this editorial we review the outcomes of an emergency department (ED) pathway for patients with mild acute pancreatitis. The goal of the pathway is to reduce hospitalizations, prevent iatrogenic complications and reduce costs, without affecting readmission rates or mortality. We discuss the clinical course and outcomes of mild acute pancreatitis patients enrolled in the pathway who were successfully discharged from the ED compared to those who were admitted to the hospital, and identify predictors of successful ED discharge to select patients who can potentially be triaged to the pathway.
