Initial Fluid Resuscitation in Acute Pancreatitis: Does an Educational Intervention Help?: 1610

Purpose: The importance of aggressive fluid resuscitation in the management of acute pancreatitis, particularly in the first 24 hours, is well established. This has been highlighted in guidelines published by major gastroenterology societies. Patients presenting to the hospital with acute pancreatitis are typically first seen by emergency room physicians. Gastroenterology consultation services are often not requested until after these critical initial hours have passed. At our institution, there was general consensus among the gastroenterologists that patients with acute pancreatitis did not receive adequate fluid resuscitation in the first 24 hours. We theorized that emergency room physicians, internists and medical and surgical residents were not aware of the guidelines for initial management of acute pancreatitis. Therefore, as part of a quality improvement project, we sought to determine whether education of initial medical providers would improve management of patients with acute pancreatitis, especially with regard to initial fluid resuscitation. Methods: A lecture on acute pancreatitis with special emphasis on fluid resuscitation was prepared by the gastroenterology fellows. This lecture was presented on four separate occasions for the departments of emergency medicine, family medicine, internal medicine and surgery. A pre-post intervention study was then undertaken. We evaluated the amount of IV fluids administered to patients admitted through the emergency room with a diagnosis of acute pancreatitis during the three month periods before and after the educational intervention. Results: In the pre-intervention group, the mean volume of fluid administered in the first 24 hours of admission was 2,827 mL, which is well below the recommended volume. The volume of fluid administered in the post-intervention group was significantly improved, with a mean volume of 4,202 mL administered in the first 24 hours (P=0.018). Conclusion: We have shown through this quality improvement project that appropriate education of first contact physicians resulted in significant improvement in initial fluid resuscitation in patients admitted with acute pancreatitis. We believe that this simple intervention may result in improved initial management of acute pancreatitis in other institutions as well.