WP5.18 - Quality Improvement Project – Assessing current practice of percutaneous cholecystostomy tube (PCT) management in a DGH and proposal of local guidelines

Abstract Rationale The absence of evidence-based guidelines for Percutaneous Cholecystostomy Tube (PCT) management has led to a lack of standardization in its care across NHS Trusts. Existing literature provides varied recommendations. Davis et al.(1999) suggested allowing 7-10 days for tract maturation, although they did not describe how this was evaluated. Other authors recommended proposals based on their local practice. Aim To establish standardized care following PCT insertion at our DGH, focusing on improving efficiency and ensuring uniformity in performance. Methods A retrospective cohort study was conducted, reviewing the period between January 2021 to December 2022. 68 patients were identified to have PCT insertions. Results Findings revealed 24% (16/68) had no documented discharge plan. 57% (39/68) of patients had a planned Surgical Assessment Unit review within a wide timeframe (4-49 days). A tubogram was arranged for 47 of 68 patients (69%) meaning the rest had no fluoroscopic examination before PCT removal. This was performed on average at 4.8 weeks and (range 1-10 weeks). 31% (21/68) had no UGI clinic review. The mean PCT removal time was 9.4 weeks with some outliers ranging between 0.5 to upto 40.5 weeks. Conclusion While some patients had PCT in-situ for longer than necessary, in two cases PCTs were removed prematurely, though no complications were recorded. The observed practice variability prompted the introduction of a local pathway, with recommendations from UGI consultants. This initiative should help prevent delays in patient care, particularly considering that the rotating junior doctors usually will lack familiarity with the management of such cases.