Clinical audit: recent practice in caring for patients with acute severe colitis compared with published guidelines--is there a problem?

Autor: Lim AH; University of Adelaide, Adelaide, South Australia, Australia. amanda.h.lim@student.adelaide.edu.au, Grafton R, Hetzel DJ, Andrews JM
Jazyk: angličtina
Zdroj: Internal medicine journal [Intern Med J] 2013 Jul; Vol. 43 (7), pp. 803-9.
DOI: 10.1111/imj.12042
Abstrakt: Background: Acute severe colitis (ASC) is a serious condition with possible outcomes of emergency colectomy and mortality. Validated guidelines exist to help avoid these.
Aims: To examine local adherence to guidelines and identify (a) opportunities to improve care and (b) possible barriers to adherence.
Methods: 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.
Results: 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).
Conclusion: 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%.
(© 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians.)
Databáze: MEDLINE
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