Clinical audit: recent practice in caring for patients with acute severe colitis compared with published guidelines - is there a problem?
Date
2013
Authors
Lim, A.
Grafton, R.
Hetzel, D.
Andrews, J.
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Internal Medicine Journal, 2013; 43(7):803-809
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A. H. Lim, R. Grafton, D. J. Hetzel and J. M. Andrews
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Abstract
<h4>Background</h4>Acute severe colitis (ASC) is a serious condition with possible outcomes of emergency colectomy and mortality. Validated guidelines exist to help avoid these.<h4>Aims</h4>To examine local adherence to guidelines and identify (a) opportunities to improve care and (b) possible barriers to adherence.<h4>Methods</h4>Retrospective, hospital-wide audit of all patients with ASC during a 2-year period (2009-2010) at a major metropolitan hospital. Cases were identified by an electronic search of all discharges with International Classification of Diseases-10 codes for colitis, colectomy, ulcerative colitis or Crohn disease.<h4>Results</h4>Twenty-six patients had 30 ASC admissions (14 female). Most admissions were under gastroenterology (25), 4 (13%) were under general medicine and 1 was under general surgery. Only 8 patients' (26%) management (all under gastroenterology) included all major details: blood investigations, Clostridium difficile test, abdominal X-ray, colonic examination and venous thromboembolism prophylaxis. Only one patient had formal severity scoring on admission, and seven patients (24%) had descriptive severity recorded. On day 3, nine patients (30%) had some recorded severity assessment; however, no formal criteria were used. Four had colectomy, three during first admission and one on re-admission. Of these patients, three received cyclosporine prior to colectomy. The mean duration of admission was 10 days (standard deviation 10.54, range 1-61).<h4>Conclusion</h4>Opportunities to optimise care exist including formal severity assessments on days 1 and 3, better deep vein thrombosis/pulmonary embolism prophylaxis and prompt colonic examination. Admission under teams other than gastroenterology appeared to be a barrier to better care. Despite the low rate of ideal management, the colectomy rate was acceptably low at 20%.
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© 2012 The Authors