Early discharge of patients with acute pancreatitis to enhanced outpatient care.

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Early discharge of patients with acute pancreatitis to enhanced outpatient care.

ANZ J Surg. 2018 Jul 08;:

Authors: Kumar VV, Treacy PJ, Li M, Dharmawardane A

Abstract
BACKGROUND: Acute pancreatitis (AP) is a common cause for hospital admission, but some patients have a prolonged stay. The aim of this study was to identify patients with mild AP who had a prolonged hospital stay, who potentially could be discharged at day 2 to enhanced outpatient care.
METHODS: Data was retrospectively collected on all patients admitted to the Royal Darwin Hospital between May 2016 and February 2017 with a diagnosis of mild AP to identify factors that may safely predict early discharge to enhanced outpatient care.
RESULTS: Of 115 admissions, 62% were male, 50% indigenous and alcohol was causative in 53%. A total of 75 (65%) patients stayed more than 2 days and used 342 bed-days. Factors identified in the first 2 days of admission associated with a length of stay more than 2 days (R2  = 0.56, P < 0.0001) included pain score >5 (P = 0.034), temperature ≥38°C (P < 0.0001), white blood cell count >18 (P = 0.036), not tolerating oral diet by day 2 (P = 0.002), severe pancreatitis on imaging (P = 0.008) and readmission in the previous 30 days (P = 0.035). Using these criteria, 57% of all admissions and 87% of admissions greater than 2 days could potentially have been transferred to enhanced outpatient care at day 2 for management. This would have saved 277 inpatient bed-days and an estimated $122 771 over the 9-month study period.
CONCLUSIONS: A significant proportion of patients admitted with mild AP, who stay longer than 2 days in hospital, could potentially be identified and discharged early to enhanced outpatient care.

PMID: 29984528 [PubMed - as supplied by publisher]

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