Improvements in care in acute pancreatitis by the adoption of an acute pancreatitis algorithm.

Acute pancreatitis is a serious condition that significantly impacts both patients and the healthcare system. The incidence of acute pancreatitis in the United States has been estimated to be 33-80 per 100,000 per year [1, 2]. From 1985-2005, hospitalizations rates for acute pancreatitis have nearly doubled, although case fatality rates have declined, likely attributed to improved therapeutic options and management [2, 3]. Despite a decrease in mortality, acute pancreatitis significantly impacts healthcare cost, with an estimated cost of acute pancreatitis in 2003 being $2.2 billion, approximately $10,000 per patient [4]. Given the significant impact on patient outcomes and healthcare costs, we, at the University of Missouri Hospital and Clinics in Columbia, examined the issue further. In 1996 and 1997, information was obtained that showed the University of Missouri Hospital and Clinics experienced a higher mortality rate (6.6%) with acute pancreatitis in comparison to similar academic medical centers in the Midwest. Subsequently, in 1997, the newly formed Office of Clinical Effectiveness began to look at ways that care could be delivered safer, better, and more cost-effective, with acute pancreatitis high on the list. Upon further investigation, not only was acute pancreatitis mortality elevated, but was ranked 13 on a list of the diagnoses that the hospital had lost money on in 1995. At that time, the committee decided that this condition met the five different criteria for institutional improvement focus, but were unclear if anything could be done about improving costs for patients with acute pancreatitis. The criteria used to select pancreatitis as the most favorable diagnosis to make a difference with were as follows: 1) there was a good opportunity for improvement in outcomes such as average length of stay compared with benchmarks that were being used at the time; 2) care of acute pancreatitis crossed multiple services including family practice, internal medicine, and surgery, bringing more expertise to the table; 3) significant variability in the way pancreatitis was being treated at the time (Departments of Internal Medicine, Surgery, and Family Practice were all involved in the care of acute pancreatitis); 4) data from secondary sources was available to measure any change; and 5) a high level of interest in making changes for the improvement of any care and its cost by various customers of the University. In the initial stages, a series of questions were investigated by the group to determine if there was variation in the care delivery …