Improve patient care pathways in patients with suspected appendicitis Digestive System
Conditions
Interventions
The intervention is the CLARITY accurate diagnosis package, which is made up of three components: the evidence based education programme (EBP), an implementation checklist and local implementation str
Sponsors
University of Birmingham
Eligibility
Sex/Gender
All
Age
16 Years to 39 Years
Inclusion criteria
Inclusion criteria: Patients: 1. Age 16 - 39 years 2. Attending hospital with right iliac fossa pain Health professionals: 1. Members of the acute general surgery team
Exclusion criteria
Exclusion criteria: Patients: 1. Previous appendicectomy 2. Current pregnancy 3. Patients with RIF pain under the care of secondary teams (other than general surgery team) Heath professionals: 1. Doctors and allied health professionals that are not part of the acute general surgical team 2. Members of the general surgical team that are not involved in the diagnostic assessment and management of patients with RIF pain
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Non-operative admission rate (NOAR) defined as the proportion of patients admitted overnight with right iliac fossa pain who did not undergo an operation. Measured by review of patient notes at 30 days follow up. Measured by the patient's admission and discharge on different dates without any record of operative intervention during their stay. This excludes patients that are subsequently admitted to hospital with missed appendicitis and readmissions. | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Negative appendicectomy rate (NAR). Defined as the proportion of patients that received a negative appendicectomy measured by review of patient notes at 30 days follow up. 2. Missed or delayed appendicitis. Proportion of patients that were not correctly diagnosed with appendicitis on their first hospital attendance and review by the surgical team. The diagnosis of appendicitis must be confirmed on radiological imaging or histology. Review of patient notes at 30 days follow up. 3. Readmission or re-attendance to hospital. Discharge from the care of the general surgical team and subsequent reattendance to hospital for RIF pain. Including all patients reattending with RIF pain or post-operatively. Excludes patients with missed appendicitis. Review of patient notes at 30 days follow up. 4. Reoperation (abdominal) for any cause, measured at 30 days follow up. 5. Surgical complications, as defined by the Clavien-Dindo classification system, measured at 30 days follow up. 6. Surgical site infection, as defined by the Centers for Disease Control criteria, measured at 30 days follow up. 7. Time from symptom onset to decision to operate and to skin incision (in hours) measured during index admission. 8. Radiological, percutaneous or laparoscopic drainage measured during index admission, measured at 30 days follow up. 9. The proportion of patients with complicated appendicitis (phlegmon, abscess or perforation), measured at 30 days follow up. 10. Admission to critical care (Level 2/3 care) for any length of time, measured during index admission. 11. Mortality (both inpatient and in the community from any cause), measured at 30 days follow up using patient notes. | — |
Countries
England, Northern Ireland, Scotland, United Kingdom, Wales
Contacts
Public ContactDion Morton
Outcome results
None listed