LAUSR

Introduction It has been established that a fast track management pathway for peri-ampullary malignancy with jaundice results in an increase in rate of surgery.1 We aimed to improve the resection rate in our HPB cancer patients referred with jaundice. All referrals are triaged on a daily basis by a Consultant Gastroenterologist. Previously, patients with jaundice were triaged to the next available gastroenterology clinic for further assessment. Such patients or those presenting to our Medical Assessment Unit were staged and fast tracked for early surgery. In March 2017 we introduced a new HPB Nurse led Jaundice clinic on our Ambulatory Assessment Area (AAA), referrals were triaged daily as usual and directed to the one of two HPB nurses to review the patients on AAA, perform a clinical assessment and organise a CT scan. Method We compared all the patients that were managed using the new strategy from March 2017 to December 2017 (10 months) to the patients referred and managed on traditional fast track pathway from March 2016 to February 2017 (12 months). We used the Somerset Cancer Registry and Electronic patient records (HIS Allscripts system). The mode of presentation, bilirubin level, cancer type and treatments were evaluated. Chi-square and t-test were used for data analysis. Results 21 patients with HPB malignancy presented with jaundice in 2016–17 compared to 22 patients referred since March 2017. Most patients had pancreatic cancer (13 in 2016 and 12 in 2017). 37 patients were referred to the AAA jaundice clinic; a cancer conversion rate of 59%. Assessment and investigation occurred more rapidly in patients triaged to the new jaundice clinic. Emergency presentations were reduced and more patients underwent surgical resection. Table. No title available. Conclusion Despite the pre-existence of a fast track pathway in place with regional HPB surgeons, triaging patients daily and routing them to a clinic appointment within 7 days as happened previously is inferior to 5 day access for clinical assessment with early CT. This local organisational change within the currently available resources has had a tremendous impact on the quality of care that we have been able to offer our patients. This has also reduced the demand for emergency admissions and one would hope will translate into an increased longer term survival rate. Reference. Roberts, et al. A reduced time to surgery within a ‘fast track’ pathway for periampullary malignancy is associated with an increased rate of pancreatoduodenectomy HPBAugust 2017;713–720.