SP7.08 Impact of an Ambulatory Pathway for Mild Acute Pancreatitis on Admitted Patients

Background The 2021 Pancreatitis: A National Cohort Study (PANC) found that nearly all patients with acute pancreatitis (AP) were admitted, with no attempts at ambulatory management. In collaboration with ASGBI and GUTS UK, an ambulatory pathway for mild AP was introduced, enabling outpatient management for approximately one-third of patients. This study evaluated the impact of the ambulatory pathway on length of stay (LOS) for those patients who were admitted. Methods From November 2023 to December 2024, a district hospital implemented an ambulatory pathway for mild AP. Admitted patients were managed as per standard care. Data included demographics, biochemistry, modified Harmless Acute Pancreatitis Score (HAPS), disease severity, re-admissions, interventions, and complications. LOS for admitted patients was compared to pre-pathway data. Results Of 144 AP patients (gallstones 42%, idiopathic 28%, alcohol 23%), 36% (52) were managed on the ambulatory pathway. There was no mortality within the ambulated patients and pain was the sole reason for re-admissions (5). Before the pathway, LOS for admitted patients was a median of 6 days. After implementation, the LOS decreased to a median of 3 days. When excluding those managed in an ambulatory manner, the admitted LOS remained significantly lower than pre-pathway (4 vs 6 days, p<0.001). Conclusion The ambulatory pathway has not only significantly reduced admissions but has counterintuitively reduced LOS for admitted patients with no direct change to their pathway. This is likely due to a cultural shift towards considering out-of-hospital management. Ongoing efforts aim to expand the pathway and optimise the discharge process.