To Identify the Adverse Outcome Arisen Due to Delay in Definite Investigation and Treatment of Patients Admitted with Obstructive Jaundice; An Audit at Royal Preston Hospital, United Kingdom

Obstructive jaundice is the type of jaundice occurred due to a blockage in the bile flow from the liver to the intestine, resulting in redirection of excess bile and its by - products such as bilirubin into the systemic blood stream. For a considerable time, Endoscopic Retrograde Cholangio-Pancreatography (ERCP) was considered as the diagnostic and therapeutic procedure of choice but after advent of Magnetic Resonance Cholangio-Pancreatography (MRCP), the role of ERCP has changed to predominantly therapeutic purpose. Other Imaging modalities include – Computerized Tomography (CT)scan, Ultrasound Sonographic Scan (USG), Endoscopic Ultra Sound Scan (EUS) and Hepatobiliary-Imino-DiaceticAcid (HIDA) scan. This audit was carried out to find out the delay in investigation between MRCP, USG and CT scan and the treatment. Patients admitted with obstructive Jaundice over the age of 16years were included. Retrospective data collection was done from 1st of January to 30th of June 2022 at Lancashire Teaching Hospital NHS Foundation Trust, United Kingdom. 20 Patients were gathered using comprehensive Integrated Health Management System - quart med (Qmed). Results showed that 80% of the investigation was done by MRCP, 15% was by CT scan and 5% wasby USG. The mean delay in getting the MRCP done was 4.19 days and among them 6.38 days of delay was seen in getting the right treatment. CT scan faced a delay of 1.67 days as a diagnostic investigation and a delay of 7.2 days was seen in getting the definitive treatment. No one faced any delay with USG as the diagnostic investigation, and mean delay of 16 days was found in getting treatment. Recommendations were given; to modify the schedules of MRCP and ERCP to improve outcomes; to identify obstructive jaundice at an early stage followed by early USG scans to start the investigation process in the presence of delaying in MRCP; to start prophylactic antibiotics for biliary sepsis when obstructive jaundice is identified; and to anticipate the need for ERCP and generate provisional lists. Further, to study the reasons in delay in ERCP; to compare administrative reasons in delay in imaging; to compare delay in MRCP with the findings of comparable hospitals; to explore the opportunity of using prophylactic antibiotics in patients with obstructive jaundice; and to re-audit with a bigger sample size; were identified as prospects for future audits.