HEALTHCARE DELIVERY
Calls for improvement in careofacutepancreatitis
The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has identified a need to improve care for acute pancreatitis, with a large number of patients failing to receive surgery when it was needed.
Acute pancreatitis (AP) is an acute inflammatory process of the pancreas and is most commonly caused by gallstones or alcohol misuse. Other causes include endoscopic procedures, trauma, surgery, metabolic conditions (such as hypertriglyceridaemia and hypercalcaemia), infections (such as mumps, coxsackie B4 virus, and Mycoplasma pneumonia), and drugs (such as thiazide diuretics, azathioprine, tetracyclines, and oestrogens).1 According to a Clinical Knowledge
Summary, published by NICE, acute pancreatitis should be suspected in “any person with acute upper or generalised abdominal pain, particularly if they have a history or clinical features of gallstones or alcohol misuse.” NICE emphasises that pancreatitis is a serious condition with a potential mortality rate of 10–25%; it has a worsening prognosis if diagnosis is delayed and is not amenable to treatment in primary care. Therefore, “urgent admission is needed in all people with suspected acute pancreatitis, without delay, for investigations and ongoing specialist management.”1 However, a recent study shows there is significant room for improvement in the care provided for patients suffering with the condition – the latest report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) reveals that patients with AP suffer preventable, repeat admissions to hospital because the cause of their pancreatitis has either not been diagnosed or
322/692) of AP, and for 22% (152/692) of patients it was alcohol excess. In 20% of cases it is very likely patients will develop a severe form of the disease and be at risk of death, and when this happens they will need critical care support and a prolonged stay in hospital Report co-author and NCEPOD Clinical
not been treated. In one in five cases (143/692) patients had had one or more previous episodes of AP and in 93% of these (121/130) the cause of readmission with AP was the same as it had been previously. Acute pancreatitis patients suffer severe pain that is caused by inflammation of the pancreas. It affects young and old, and in just one six-month period in 2014 over 14,000 people were admitted to hospital with AP. NCEPOD identified that gallstones were the most common cause (46.5%;
The latest report from the National Confidential Enquiry into Patient Outcome and Death reveals that patients with acute pancreatitis suffer preventable, repeat admissions to hospital because the cause of their pancreatitis has either not been diagnosed or not been treated.
OCTOBER 2016
Co-ordinator Derek O’Reilly said that the report found a worryingly high number of repeat admissions where the cause of AP had been the same as it had been in the previous admission to hospital. He warned: “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. “Repeat hospital stays would be reduced significantly if patients with mild acute pancreatitis had surgery to remove gallstones within two weeks of admission.” Derek O’Reilly highlighted antibiotic overuse: “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 of AP, encourages the growth of resistant strains of bacteria, and wastes NHS resources.” He also highlighted concerns about how hospitals care for AP patients with alcohol problems: “Where alcohol misuse was associated with AP we found that only half (51%; 28/52) of the patients reviewed were referred to an alcohol liaison service, despite 80% of hospitals in the study having onsite services. Clinicians are missing a significant opportunity to change the future quality of life for patients by helping them to stop harmful levels of drinking, and importantly prevent AP reoccurring.” Report co-author and NCEPOD clinical coordinator, Simon McPherson, said: “We found in too many cases of acute pancreatitis clinicians never found the underlying cause (17.5%; 121/692) of the illness. If ultrasound scans had been used to detect gallstones, for example, along with more
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