HPB SO60 - A Re-Audit: Radiological Investigations In Patients Diagnosed With Gallstone Disease

Abstract Background Gallstones disease is very commonly encountered in general surgery and often detected by different modes of imaging. NICE guidance advises offering liver function tests and ultrasound where gallstones are suspected. MRCP and EUS are then considered if gallstones have not been detected. However, ultrasound is not always offered first line in patient cases, for varying reasons. This retrospective audit aims to assess the different radiological investigations used in gallstones against NICE guidance and the reasons behind this. Method Data was collected from a cohort of 108 patients over a 2 month period, all diagnosed with gallstones. The data collected included information regarding their demographics and imaging used to diagnose gallstones, as well as the reasoning when the first line investigation was not used. These results were then presented at the local general surgery CGM, findings were also communicated to doctors within the hospital. The audit was then repeated a year later with a similar cohort of patients, to compare findings. Results Mean age of patients decreased from initial audit to reaudit periodFemale preponderance in both audit and re-audit cyclePatients more likely to have imaging when abdominal pain present AND deranged LFTs as opposed to just one of the twoComparing total number of scans: less patients are undergoing CT scans (44 in audit period vs 31 in re-audit period)- 30% decreaseDecrease in number of patients having CTAP as first mode of scan (38 in audit period vs 21 in re-audit period). Total of 45 % drop. Conclusion While ultrasound scan is the first line radiological investigation where gallstones are suspected, it is not always the first to be used. This is for a plethora of reasons, including:Differing clinical judgment/ diagnostic uncertaintyDifferent clinicians/ specialities booking investigationsUnawareness of NICE guidanceLogistical delay in ultrasounds However, it does appear there has been improvement in adherence to NICE guidance between first and second cycle. Other modes of awareness will be implemented to further improve this, including publishing further guidance about NICE protocol within the trust so this is more easily accessible to doctors.