Acute Pancreatitis Management and Scoring in the Department of General Surgery, Northwick Park Hospital, 2022-2024

Acute pancreatitis is a common cause of acute abdominal admissions, which usually resolve on their own; however, early severity stratification guides escalation of care and resource utilization. Early and accurate severity assessment using standardized scoring systems, such as the modified Atlanta classification, is crucial for effective clinical management and improved outcomes in patients with pancreatitis. Therefore, we conducted this clinical audit to highlight the use of the Atlanta scoring system. We designed this closed-loop audit to bridge the gap between national recommendations and clinical practice, with a focus on improving early risk stratification and patient management for acute pancreatitis at Northwick Park Hospital.

This study was a retrospective analysis conducted at Northwick Park Hospital, Department of General Surgery. Our audit was done over two separate cycles. The first cycle included 64 patients in 2023 from Epro and Cerner, while the second cycle included 80 patients in 2024 from Cerner. Between the two cycles, several interventions were introduced, including departmental teaching, visual prompts such as posters, and digital communications via email and messaging platforms. Scoring practices included the modified Atlanta score, the Modified Marshall scoring system, and the Glasgow-Imrie score. The audit was conducted in accordance with National Institute for Health and Care Excellence (NICE) NG104 guidelines and was approved through local clinical governance meetings for both audit cycles, with the consultant's agreement to implement updated scoring protocols.

The first audit cycle in 2023 revealed that only 30% of patients had documented scoring on admission, and none had repeated scoring at 48 hours. The second cycle in 2024 demonstrated improvement, with admission scores increasing from 30% to 40%. Atlanta classification scoring on admission and 48 hours post-admission increased from 0% in the first cycle to 7.5% in the second cycle.

This quality improvement initiative demonstrated that targeted interventions significantly enhance adherence to national scoring protocols, thereby improving standardized acute pancreatitis care. However, continuous attention must be paid to assess and improve the use of severity scoring systems in the management of acute pancreatitis, in addition to increasing the frequency and consistency of applying the Revised Atlanta Classification at the time of admission and 48 hours post-admission.