SP4.08 Enhancing Pediatric Appendicitis Care in Alignment with GIRFT Guidelines: A Two-Cycle Audit at a District Hospital

Aims The audit aimed to evaluate the management of pediatric appendicitis at a District Hospital against GIRFT (Getting It Right The First Time, June 2022) guidelines. It sought to identify areas for improvement in diagnostic pathways, surgical timing, and antibiotic protocols across two audit cycles. Methods A retrospective review was conducted over two cycles: the first from May to October 2022 (27 patients) and the second from January to December 2023 (48 patients). Data included demographics, time to surgery, pre- and post-operative antibiotic use, histological outcomes, and complications. Results In the first cycle, the negative appendicectomy rate was 22%, and the median time to surgery was 23 hours. Antibiotics were inconsistently prescribed pre-operatively (81%) and post-operatively, with limited adherence to best practice. The complication rate was 18%. By the second cycle, interventions had reduced the negative appendicectomy rate to 4%, aligning below the national average of 10%. The median time to surgery improved to 19.25 hours, with 85% of patients receiving pre-operative antibiotics. However, unnecessary post-operative antibiotics were given in 35% of simple cases, and only 86% of complex cases met the 48-hour guideline. Complication rates fell to 6%. Conclusions The second cycle demonstrated significant improvements in negative appendicectomy rates, time to surgery, and complication rates, reflecting enhanced adherence to GIRFT guidelines. However, variability in antibiotic prescribing persists, necessitating protocol standardization. Continued focus on diagnostic tools, such as clinical scoring and imaging, and consistent antibiotic stewardship are crucial for sustaining and furthering these improvements.