Funding: R. Grafton has received financial support from Abbott Australia and MSD. D. J. Hetzel has received financial support from Reckitt-Benckiser, DVA/Admin Tribunal, Astra Zeneca, Abbott Australia and Janssen. J. M. Andrews has received financial support and/or speakers fees from Abbott, AstraZeneca, Janssen, Ferring, Fresenius Kabi, Schering-Plough and MSD.
Clinical audit: recent practice in caring for patients with acute severe colitis compared with published guidelines – is there a problem?
Article first published online: 11 JUL 2013
© 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 43, Issue 7, pages 803–809, July 2013
How to Cite
Lim, A. H., Grafton, R., Hetzel, D. J. and Andrews, J. M. (2013), Clinical audit: recent practice in caring for patients with acute severe colitis compared with published guidelines – is there a problem?. Internal Medicine Journal, 43: 803–809. doi: 10.1111/imj.12042
Conflict of interest: D. J. Hetzel has served on the advisory boards for Schering-Plough and Reckitt-Benckiser. J. M. Andrews has served on the advisory boards for Abbott Australia, MSD/Schering-Plough, Ferring, Fresenius Kabi and Janssen-Cilag Australia.
- Issue published online: 11 JUL 2013
- Article first published online: 11 JUL 2013
- Accepted manuscript online: 23 NOV 2012 09:31AM EST
- Manuscript Accepted: 28 OCT 2012
- Manuscript Received: 9 AUG 2012
- Abbott Australia
- DVA/Admin Tribunal
- Astra Zeneca
- Fresenius Kabi
- inflammatory bowel disease;
Acute severe colitis (ASC) is a serious condition with possible outcomes of emergency colectomy and mortality. Validated guidelines exist to help avoid these.
To examine local adherence to guidelines and identify (a) opportunities to improve care and (b) possible barriers to adherence.
Retrospective, hospital-wide audit of all patients with ASC during a 2-year period (2009–2010) at a major metropolitan hospital. Cases were identified by an electronic search of all discharges with International Classification of Diseases-10 codes for colitis, colectomy, ulcerative colitis or Crohn disease.
Twenty-six patients had 30 ASC admissions (14 female). Most admissions were under gastroenterology (25), 4 (13%) were under general medicine and 1 was under general surgery. Only 8 patients' (26%) management (all under gastroenterology) included all major details: blood investigations, Clostridium difficile test, abdominal X-ray, colonic examination and venous thromboembolism prophylaxis. Only one patient had formal severity scoring on admission, and seven patients (24%) had descriptive severity recorded. On day 3, nine patients (30%) had some recorded severity assessment; however, no formal criteria were used. Four had colectomy, three during first admission and one on re-admission. Of these patients, three received cyclosporine prior to colectomy. The mean duration of admission was 10 days (standard deviation 10.54, range 1–61).
Opportunities to optimise care exist including formal severity assessments on days 1 and 3, better deep vein thrombosis/pulmonary embolism prophylaxis and prompt colonic examination. Admission under teams other than gastroenterology appeared to be a barrier to better care. Despite the low rate of ideal management, the colectomy rate was acceptably low at 20%.