BN SO23 - From referral to resolution, impact of acute biliary pathway on patients care

Abstract Background At our trust, we introduced acute biliary pathway to efficiently manage patients presenting with acute biliary pathology. This pathway begins with a referral form containing relevant patient information for triage. A triage team reviews these forms and classifies patients into three categories based on specific criteria. Method Patients are triaged into three categories:Red: Patients needing emergency surgery during the same admission.Amber: Patients requiring urgent but non-emergency care, scheduled for an outpatient (OP) appointment for consent, followed by a laparoscopic cholecystectomy within 2-3 weeks or 6-8 weeks, based on the pathology.Green: Patients who do not meet the criteria for red or amber are referred for further outpatient assessment before definitive management. Results Over four months , 202 referrals were received. Approximately 50% (102 patients) were referred to the outpatient department. Of the remainder, 45% were categorised as red and had IP cholecystectomy, with a mean length of stay of 1.5 days post-surgery across 30 operations. The remaining patients were managed as amber, resulting in 22 operations. The total complication rate was low, with only 2 cases managed conservatively, and 4 patients required re-admission before definitive treatment. The average wait time for a clinic appointment was 2 weeks, while the average wait time for surgery was 8 weeks, with a total of 6 cancellations. Conclusion The acute biliary pathway demonstrates effectiveness through a low complication rate and timely management of patients. This approach improves the efficiency of patient care and reduces the need for emergency re-admissions. More importantly, this model is straightforward enough to be implemented in any high-volume centre with a sufficient level of expertise in treating biliary patients.