Introduction The ‘Jaundice Hotline’ was introduced in our hospital in 2013 to facilitate prompt referral of patients with acute onset jaundice in the community via a dedicated ambulatory pathway to expedite appropriate management of biliary obstruction. The faxed referrals are reviewed by a consultant gastroenterologist who requests appropriate imaging or intervention. The results are tracked by a designated secretary and actioned by the consultant. In 2014, we negotiated with our radiology department for once a week dedicated ultrasound and MRCP slots for patients on this pathway. We present data from our experience of developing this service over a 2-year period.
Method All referrals from the database in 2013 and 2014 were analysed retrospectively. We calculated the time intervals from referral to first consultant decision and time intervals between subsequent investigations before biliary intervention. We divided the data into three groups: all pathology, choledocholithiasis and hepatobiliary cancers. The effect of introducing dedicated ultrasound and MRCP slots were analysed by comparing the mean times between the two years.
Results A total of 203 referrals (n = 109 in 2013, n = 94 in 2014) were analysed: choledocholithiasis (n = 72), hepatobiliary cancers (n = 32), cholelithiasis (n = 36), liver disease (n = 23) and others (n = 40).
For all pathology, we managed to half the average time from referral to first decision by a consultant in 2014. The mean waiting time for ultrasound as the first choice of investigation improved by 3.2 days and for MRCP by 3.1 days in 2014. It took on average 3.2 days longer to obtain a CT in 2014.
For choledocholithiasis, the time interval from referral to ERCP in 2013 (2–49 days, mean = 18.1) were similar to 2014 (2–47 days, mean = 17.0) despite mean improvement of 2.2 days and 2.8 days in the waiting times for ultrasound and MRCP respectively. This was due to selected cases where CT was also required as it took on average 5.8 days longer to obtain a CT in 2014 in this group.
For cancers, the time from referral to biliary decompression (ERCP/PTC) improved by 3.5 days from 2013 (9–34 days, mean = 20.9) to 2014 (4–29 days, mean = 17.4). The mean time from imaging to MDT was 5.9 days in 2013 and from MDT to biliary intervention was 3.1 days. This trend was similarly observed in 2014 at 5.1 days to MDT and 3.4 days to intervention in 2014. The majority of the time was spent waiting for CT scan.
Conclusion The positive impact of having dedicated ultrasound and MRCP slots to reduce waiting times for biliary intervention has overall been dampened by the increasing pressures on cross-sectional imaging in hospital medicine. We aim to conduct subanalysis of cholangitis and admission rates for this cohort to negotiate dedicated CT scan slots for this pathway to improve the efficiency of outpatient management of biliary obstruction.
Disclosure of interest None Declared.
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