745 Improving Time to ERCP for Acute Gallstone Cholangitis Admissions at a District General Hospital: A Closed Loop Audit

Background NICE guidelines recommend prompt endoscopic retrograde cholangiopancreatography (ERCP) within 72 hours for adults with acute gallstone cholangitis, especially in moderate-to-severe cases. We audited our management of obstructive gallstone disease to enhance timely access to ERCP. Method We conducted a closed loop audit at a UK district general hospital, assessing time to ERCP for patients with acute gallstone cholangitis. Severity was graded using the 2018 Tokyo Guidelines. Data was collected over a 5-month period (01/05/2023 to 01/10/2023), analysed and presented to the surgical multi-disciplinary team. Additional referral pathways to 3 nearby tertiary care centre for ERCP were established. Post-intervention admissions were re-audited over a second 5-month period (01/01/2023 to 01/06/2023) to assess the effect of the new referral pathways. Results Forty-one patients underwent ERCP for acute gallstone cholangitis. Pre-intervention, median time to ERCP overall was 10 days (5–24), 8 days (5–19) for moderate-to-severe cases, and 28 days (9–46) for mild cases. Post-intervention, median time to ERCP overall was 6 days (4–9), 6 days (6–8) for moderate-to-severe cases, and 4 days (4–25) for mild cases. Median length of stay pre- and post-intervention was 8 (6–13) and 7 days (4–10), respectively. Conclusions By establishing referral pathways to tertiary care centres, we successfully reduced time to ERCP for local patients with moderate-to-severe cases. This change contributed to shorter waiting times for ERCP in mild cases and decreased overall length of stay. Collaborative efforts between district general hospitals and tertiary centres improve outcomes in the management of acute gallstone cholangitis.