C0019 - Perfusing the Pancreas: A Quality Improvement Project to Optimize Pancreatitis Management in a Tertiary Academic Center

Cynthia N. Tran, MD, Cindy Ye, MD, Kevin Do, MD, Audrey Duquette, BS, Angela Ward, ARNP, Kavya Sebastian, MD, Joshua D. Novak, MD, Vaishali Patel, MD
Emory University School of Medicine, Atlanta, GA

Introduction: Acute pancreatitis (AP) is one of the leading gastrointestinal (GI) causes of hospitalization. Numerous studies have addressed the role of early fluid resuscitation and nutrition initiation in reducing the morbidity and length of stay associated with AP. Multiple GI societies have developed guidelines on the optimal management of AP. At our institution, we observed variations in the management of AP from current guidelines. We aim to identify the trends in the management of AP and the barriers to guideline adherence. We plan to use this data to enact systematic interventions that improve adherence to guideline recommendations.

Methods: We evaluated all patients hospitalized with a diagnosis of acute or acute-on-chronic pancreatitis (ACP) from September to December 2021. Pre-intervention data on fluid resuscitation and initiation of oral diet/enteral feeding were collected. A survey was also developed and sent to hospital medicine and teaching teams to identify potential barriers. A Pareto chart showed that knowledge was not the primary barrier. Rather, there were clinical concerns that aggressive fluid resuscitation and early nutrition initiation could lead to potential complications of volume overload and worsening pancreatitis severity.

Results: We reviewed data for 74 patients admitted with a diagnosis of AP or ACP. 93% of patients received intravenous fluids (IVF) within the first 24 hours, but only 8.5% received the recommended resuscitation rate of at least 250 cc/hr. With regards to nutrition, 46% of patients admitted with AP received oral/enteral nutrition within the first 24 hours. A Pareto chart of these responses identified that the biggest barriers to aggressive IVF resuscitation were concern for volume overload and patient co-morbidities, such as congestive heart failure and chronic kidney disease. A subsequent secondary analysis showed that the concern for CHF and CKD may not be valid, as 81% of patients admitted for AP did not have these co-morbidities. For early nutrition, the biggest barriers were concern for clinical worsening and PO intolerance.

Discussion: Our QI project aims to optimize pancreatitis management at our institution by improving adherence to early fluid resuscitation and oral/enteral nutrition initiation. A pro forma is in development to standardize management and will be distributed to clinical staff. Post-intervention data will be collected to assess for improvement.


Disclosures:


Cynthia N. Tran, MD, Cindy Ye, MD, Kevin Do, MD, Audrey Duquette, BS, Angela Ward, ARNP, Kavya Sebastian, MD, Joshua D. Novak, MD, Vaishali Patel, MD. C0019 - Perfusing the Pancreas: A Quality Improvement Project to Optimize Pancreatitis Management in a Tertiary Academic Center, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.