S275 Acute Pancreatitis Clinical Pathway: An Educational Needs Assessment Among Residents

Introduction: Standardized, evidence-based clinical pathways have improved adherence to best practices for myriad complex diseases. Adherence to best practices in acute pancreatitis (AP) is poor, yet AP clinical pathways have been underutilized. Current knowledge gaps include provider perceptions of AP pathways, and which knowledge domains benefit from educational intervention -particularly at the trainee level. At our institution, patients hospitalized with AP are managed primarily on the internal medicine or intensive care services. Therefore, the aim of this survey-based needs assessment was to characterize internal medicine residents’ comfort level with AP management and their attitudes towards implementation of an AP clinical pathway in Epic. Methods: Surveys were distributed to 124 residents within the department of Internal Medicine at a tertiary care academic medical center. Descriptive statistics were reported. Results: Seventy-nine of 124 residents completed the survey (64%). 33% were 1st year residents, 32% second year, and 35% third or fourth year. Domains of AP management with high comfort levels (i.e., ‘comfortable’ or ‘very comfortable’) included diagnosis (98%), laboratory workup (86%), use of imaging (84%), overall management (71%), management of intravenous fluids (63%), and diet/enteral nutrition (74%). In contrast, fewer were ‘comfortable’ or ‘very comfortable’ in determining when to use antibiotics (32%), which consultations to place (41%), and which specialty follow-up to coordinate after discharge (24%). These trends persisted even amongst third and fourth year residents. Overall, 78% felt pathways increased their adherence to clinical best practices, while 74% felt they improved comfort levels with AP management either ‘a little’ or ‘a lot’. Overall, 95% felt an AP pathway would improve adherence to clinical best practices, and 92% felt it would improve comfort level among providers. Conclusion: This needs-assessment demonstrates most residents (even at advanced training levels) were not comfortable with antibiotic management, appropriate consultations, and specialty care coordination on discharge in AP. There was overwhelming interest in an AP clinical pathway. Our findings justify design of an AP clinical pathway with specific domains for targeted educational interventions. Impact will be system-wide pathway implementation and analysis of post-implementation outcomes and practice patterns.