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Post-operative care following appendicectomy ? Are we getting it right first time?
Lloyd. A
Background: ‘Getting It Right First Time’ (GIRFT) identified
significant variation in length of stay following appendicectomy,
with leading trusts ‘able to discharge over
half of patients within two days of admission’ (1). Our
aim was to analyse length of stay following appendicectomy
at Stockport NHSFT.
Methods: We audited 98 patients undergoing appendicectomy
between June and December 2017, using the
GIRFT 48-hour target as our audit standard for length of
stay in uncomplicated appendicitis (i.e. no perforation,
empyema or abscess formation). Online case notes were
used to identify length of stay, diagnosis and barriers to
discharge. We conducted a re-audit of 144 patients undergoing
appendicectomy between October 2018 and April
2019.
Results: Our initial audit identified 61 cases of uncomplicated
appendicitis with an average stay of 2.52 days. We
identified unnecessary post-operative IV antibiotic prescriptions
(2) and inadequate analgesia as leading causes
of delayed discharge. Our re-audit identified 102 cases of
uncomplicated appendicitis with an average stay of 2.30
days.
Discussion: GIRFT’s 48-hour target is achievable with
diligent use of supportive therapies and avoidance of unnecessary
IV antibiotic prescriptions. We created a template
operation note for use within our department and
raised awareness of our findings. Our re-audit identified
a significant improvement in average length of stay.