BN SO35 - A Novel Ambulatory Pathway in the Management of Acute Pancreatitis

Abstract Background Acute Pancreatitis (AP) accounts for 20000 admissions per year, resulting in an average hospital stay of 5 days. Over 90% of patient have mild or moderate disease severity. Validated risk stratification tools such as the Harmless Acute Pancreatitis (HAP) score utilised alongside biochemical markers and clinical acumen can predict up to 97% of patients with a mild disease course. A pathway was introduced at two NHS centres to enable diagnosis and ambulatory management of patients with predicted mild AP with the aim of improving patient experience by preventing unnecessary admission, reducing pressure on surgical departments and providing safe outpatient management. Method The study took place at two sites: a district general hospital (DGH) and a tertiary referral centre. Pathway development occurred in parallel to pilot. Ambulation was defined as no overnight stay in a hospital bed. An initial retrospective review of all AP admissions was undertaken to understand current burden of disease and severity in our centres. Suitable patients were identified prospectively and data (demographics, biochemical markers, modified HAP score, severity of disease, complications, re-admission rate, surgical or endoscopic intervention) were collected for up to 30 days after discharge. AP ‘proforma’ were created to understand surgeons decision-making surrounding ambulation versus admission. Results Between November 2023 and May 2024, 99 patients with AP presented to the DGH surgical unit. Causes of AP included gallstones (n=55), idiopathic (n=21), alcohol (n=17), and post-ERCP (n=2). 38 patients (38%) were ambulated, with 23/38 (61%) returning for planned review within 72 hours. There were no mortalities in the ambulatory group. Three (7%) ambulated patients were re-admitted within 30 days for pain control (n=2) and post-cholecystectomy complications (n=1). Reasons for non-ambulation included: pain (n=30), inpatient cholecystectomy (n=4), poor oral intake (n=4), social reasons (n=3). In 4-week tertiary data collection, 5/17 (29%) eligible patients were ambulated, with 1 (20%) re-admission. Conclusion Pilot of a novel pathway to identify and ambulate patients with a predicted mild course of AP has been successful across two NHS centres. Use of validated risk scores alongside biochemical markers and clinical acumen produces a safe, sustainable and effective pathway that reduces burden on inpatient surgical resources. It is safe and feasible to ambulate patients with AP whilst undertaking diagnostic imaging, managing symptoms, facilitating expedited cholecystectomy and arranging specialist review in the outpatient setting. Further work is required with stakeholders to refine the pathway and replicate these results in other surgical units.