337 Improving the Accuracy of Drain Lipase Testing Following Pancreatectomy: A Quality Improvement Project

Abstract Introduction Postoperative pancreatic fistula (POPF) is the leading cause of post-pancreatectomy mortality and morbidity (Kanda et al., 2014). Early detection and timely management are essential to improving patient outcomes. The 2016 International Study Group of Pancreatic Surgery (ISGPS) defines POPF as a drain fluid amylase level of three times the institutional upper limit of serum amylase on or after postoperative day (POD) 3(Bassi et al., 2017). At the MRI Hepato-Pancreato-Biliary (HPB) department, drain fluid lipase (DFL) is used instead due to its higher sensitivity. However, observations raised concerns about inconsistent adherence to this protocol. Aim To achieve 100% compliance with POD 3 DFL testing in all eligible post-pancreatectomy patients by identifying causes of delay and employing interventions. Method Data was collected retrospectively on patients who underwent pancreatectomies including dates and results of drain lipase tested, reasons for delayed testing, incidence and management of POPF. The Model for Improvement and a total of 4 PDSA cycles were performed. Interventions included educational posters, a pre-filled ward round and op-note template providing clear instructions. Results Prior to the interventions, only 61.7% of patients were timely tested. The root cause was a lack of awareness. POPF was diagnosed more frequently in timely tested patients; 70.7% vs 27.8%. Also, the incidence of clinically relevant POPF in the delayed testing group was higher (70% vs 43.9%). At the end of the fourth cycle, a 100% compliance rate was achieved. Conclusions Correct DFL testing allows for earlier diagnosis and resultant expectant management to be initiated resulting in better patient outcomes.