MSSP772: AN EDUCATIONAL INITIATIVE AND INSTITUTIONAL PATHWAY TO GUIDE MULTIDISCIPLINARY MANAGEMENT OF GALLSTONE DISEASE: A QUALITY IMPROVEMENT PROJECT
Elizabeth L Barbera, MD1; Rafaela Izurieta, MD2; Robert D Barbera, MD3; Jonathan McKeegan, MD4; Michael J Yoo4; Jerome C Edelson2; John G Quiles, MD2; Theodore G Hart1; 1Department of Surgery, Brooke Army Medical Center, San Antonio, TX; 2Department of Gastroenterology, Brooke Army Medical Center, San Antonio, TX; 3Department of Medicine, Brooke Army Medical Center, San Antonio, TX; 4Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX
Background/Objectives: Gallstone disease constitutes a significant health problem in the United States and is a leading cause for gastrointestinal-related hospital admissions both nationally and at our institution (1,2). A substantial variation in practice exists at our institution for care of patients with gallstone disease. This variation may lead to prolonged length of stay (LOS), unnecessary imaging, delays to procedures, patient distress, and other undesirable outcomes. The goal of this quality improvement project was to standardize care of patients with gallstone disease at our institution. Our aim was to create a shared understanding among departments regarding management via provider education and creation of a multidisciplinary evidence-based guideline for gallstone disease.
Methods: A multidisciplinary taskforce was created, composed of general surgery (GS), gastroenterology (GI), emergency medicine, and internal medicine department members. Key drivers included provider education and creation of a pathway guiding workup and management of patients with symptomatic cholelithiasis, acute cholecystitis, choledocholithiasis and/or gallstone pancreatitis, and ascending cholangitis. Creation of the guidelines was supported by a literature review and planned implementation will be via Plan-Do-Study-Act cycles, with data monitored at the three-month interval. A questionnaire was developed to collect demographics and assess current understanding of institutional management of gallstone disease both before and after department education. In addition to basic demographics, key domains to be assessed include degree of training, fund of knowledge, and institution practice patterns. An interrater reliability assessment will be performed via Cohen’s K-coefficient testing.
Results: The project was initiated in May 2024. Guidelines were developed in August 2024. Educational presentations and guideline proposal to individual departments are underway. Pre- and post-presentation questionnaires have been collected for the GS and GI departments. Current response rate is 80 participants (65% resident participation; 25% PGY1). Of current participants, 87.5% report confusion among services when caring for a patient with gallstone disease at our institution, despite 88.8% reporting adequate program education and training to make informed management decisions. Results are ongoing with expected completion and analysis by December 2024.
Conclusions: Gallstone disease remains a common criterion for inpatient admission at our institution. Effective care of these patients requires a multidisciplinary approach. Management can be streamlined with quality improvement initiatives to facilitate a shared institutional understanding of workup and treatment. Current efforts focus on education and development of formal institutional guidelines, but future inquiries will be directed towards assessing patient outcomes including LOS, time to surgery, and patient satisfaction.