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Non-compliance with national guidelines in the management of acute pancreatitis in the United kingdom

Non-compliance with national guidelines in the management of acute pancreatitis in the United kingdom
Non-compliance with national guidelines in the management of acute pancreatitis in the United kingdom
Background: deficiencies and lack of standardisation of the management of acute pancreatitis in the UK have been reported. National UK guidelines for the management of acute pancreatitis were published in 1998. However, implementation of national guidelines in other areas has been patchy, suggesting that evaluation of the uptake of the pancreatitis guidelines would be appropriate.
Aim: identification of current practice in the management of acute pancreatitis as reported by consultant surgeons, in order to determine how effectively the UK guidelines have been introduced into practice.
Methods: a questionnaire was posted to 1,072 full members of the Association of Surgeons of Great Britain and Ireland. It consisted of 13 questions that aimed to identify the surgeon's practice in the management of patients with acute pancreatitis in relation to key points in the UK guidelines. We compared the practice of hepatobiliary and pancreatic (HBP) vs. non-HBP specialists, and teaching vs. non-teaching hospital surgeons using the chi2 test.
Results: of 538 responses (50%), 519 were from consultant surgeons. 59 did not look after patients with acute pancreatitis and 89 (17%) had a HBP interest. There were differences between the recommendations in the guidelines and reported practice, particularly in the use of critical care resources and referral to specialist units. Of consultants looking after acute pancreatitis 371 (72%) were non-HBP specialists. There were significant overall differences between the practice of HBP specialists and non-specialists: in severity assessment (Glasgow and C-reactive protein vs. Ranson criteria); indication and timing of requesting computed tomography (routinely at 7-10 days vs. when clinically indicated); nutritional support (enteral feeding vs. no support), and in common bile duct assessment prior to cholecystectomy (intra-operative cholangiography vs. endoscopic retrograde cholangiopancreatography). There was no significant difference between practice in teaching and non-teaching hospitals.
Conclusion: implementation of national guidelines for the management of acute pancreatitis was greater in the practice of HBP specialists than non-specialists. This has implications for the rationale of creating guidelines, and for the strategies associated with their introduction.
acute pancreatitis, pancreatitis guidelines
0253-4886
192-198
Aly, Emad A.H.
574d40dc-de57-4f36-9438-bf4c4341283a
Milne, R.
37b95431-12f3-4aa7-86f8-a632825df7ae
Johnson, C.D.
e50aa9cd-8c61-4fe3-a0b3-f51cc3a6c74a
Aly, Emad A.H.
574d40dc-de57-4f36-9438-bf4c4341283a
Milne, R.
37b95431-12f3-4aa7-86f8-a632825df7ae
Johnson, C.D.
e50aa9cd-8c61-4fe3-a0b3-f51cc3a6c74a

Aly, Emad A.H., Milne, R. and Johnson, C.D. (2002) Non-compliance with national guidelines in the management of acute pancreatitis in the United kingdom. Digestive Surgery, 19 (3), 192-198. (doi:10.1159/000064212).

Record type: Article

Abstract

Background: deficiencies and lack of standardisation of the management of acute pancreatitis in the UK have been reported. National UK guidelines for the management of acute pancreatitis were published in 1998. However, implementation of national guidelines in other areas has been patchy, suggesting that evaluation of the uptake of the pancreatitis guidelines would be appropriate.
Aim: identification of current practice in the management of acute pancreatitis as reported by consultant surgeons, in order to determine how effectively the UK guidelines have been introduced into practice.
Methods: a questionnaire was posted to 1,072 full members of the Association of Surgeons of Great Britain and Ireland. It consisted of 13 questions that aimed to identify the surgeon's practice in the management of patients with acute pancreatitis in relation to key points in the UK guidelines. We compared the practice of hepatobiliary and pancreatic (HBP) vs. non-HBP specialists, and teaching vs. non-teaching hospital surgeons using the chi2 test.
Results: of 538 responses (50%), 519 were from consultant surgeons. 59 did not look after patients with acute pancreatitis and 89 (17%) had a HBP interest. There were differences between the recommendations in the guidelines and reported practice, particularly in the use of critical care resources and referral to specialist units. Of consultants looking after acute pancreatitis 371 (72%) were non-HBP specialists. There were significant overall differences between the practice of HBP specialists and non-specialists: in severity assessment (Glasgow and C-reactive protein vs. Ranson criteria); indication and timing of requesting computed tomography (routinely at 7-10 days vs. when clinically indicated); nutritional support (enteral feeding vs. no support), and in common bile duct assessment prior to cholecystectomy (intra-operative cholangiography vs. endoscopic retrograde cholangiopancreatography). There was no significant difference between practice in teaching and non-teaching hospitals.
Conclusion: implementation of national guidelines for the management of acute pancreatitis was greater in the practice of HBP specialists than non-specialists. This has implications for the rationale of creating guidelines, and for the strategies associated with their introduction.

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More information

Published date: 2002
Keywords: acute pancreatitis, pancreatitis guidelines

Identifiers

Local EPrints ID: 26190
URI: http://eprints.soton.ac.uk/id/eprint/26190
ISSN: 0253-4886
PURE UUID: bc1fc1eb-68c1-40e4-82b6-f58443ffd59f

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Date deposited: 20 Apr 2006
Last modified: 15 Jul 2019 19:14

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