158 Efficiency of Outpatient Management of Biliary Colic at a District General Hospital

Abstract Aim To evaluate adherence to the outpatient management protocol for biliary colic at a district general hospital and assess the efficiency of care delivered in reducing unnecessary admissions and streamlining follow-up. Method A retrospective audit was conducted over a 6-month period, including 49 patients who presented to the emergency department with symptoms suggestive of biliary colic. Data were collected from electronic health records and included clinical presentation, inflammatory markers, ultrasound imaging, analgesia prescription, dietary advice, safety netting, and follow-up arrangements. Outcomes were assessed against local trust guidelines and pathway standards. Results Of the 49 patients, 71% (35/49) had an outpatient ultrasound ordered, aligning with pathway recommendations. However, only 16% (8/49) received documented dietary advice, and 26% (13/49) received safety netting advice. Follow-up via the SAU/EGSAC pathway was arranged for 53% (26/49), while 3 patients sought private care and 20% had no clear follow-up documented. Analgesia was prescribed in most cases, though quality of documentation varied. Notably, some patients represented to ED due to insufficient discharge planning or missed investigations, indicating lapses in pathway adherence. Conclusions This audit demonstrates variable compliance with the established outpatient biliary colic management pathway, particularly regarding safety netting, dietary advice, and structured follow-up. Such gaps may contribute to avoidable representations and increased hospital burden. Recommendations include introducing a standardised discharge proforma, clinician education, and improved documentation practices. These interventions aim to optimise pathway utilisation, improve patient safety, and reduce strain on acute services. A re-audit is planned to assess the effectiveness of these changes.