Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Future Healthcare Journal

  • FHJ Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About FHJ
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Future Healthcare Journal

futurehosp Logo
  • FHJ Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About FHJ
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Assessment of abdominal pain in older people: a quality improvement project in the emergency department

Nur Nurmahomed, Robert Bickerton and Claire Bronze
Download PDF
DOI: https://doi.org/10.7861/fhj.9-2-s94
Future Healthc J July 2022
Nur Nurmahomed
ASt Mary's Hospital, London, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Robert Bickerton
ASt Mary's Hospital, London, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Claire Bronze
ASt Mary's Hospital, London, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
Loading

Introduction

The cause of acute abdominal pain can hold great uncertainty. In older people this is further complicated by co-existent disease, delays in presentation and physical/social barriers. With increased risk of serious and rapidly progressive pathology associated with a 6–8-fold increase in mortality in comparison to younger patients.1 At present, there is no defined pathway in the assessment of older patients with acute abdominal pain. This QIP aims to look at the assessment of older patients presenting with abdominal pain to St Mary's Hospital London emergency department.

Methods

Older patients over the age of 70 years presenting with abdominal pain were retrospectively selected. Data was collected on baseline demographics, comorbidities, investigations/imaging, senior review assessment and referral to specialty. After the initial audit, we presented a slide detailing triage investigations daily at morning handover, and held a teaching session for doctors assessing these patients. We then re-audited in two subsequent cycles to assess the efficacy of these interventions.

Results and discussion

Between 1–17 October 2021, 45 patients over the age of 70 presented with abdominal pain. Overall, the majority of patients were men (62%), the median age was 80.3 years and 20% of patients had four or more comorbidities. Hypertension (15%) and type II diabetes mellitus (15%) being the most common. Only 5–6% of patients had previous surgery or existing abdominal pathology. 92% of patients had a C-reactive protein (CRP) test, 68% had an amylase and 84% had a venous blood gas lactate test. 49% had a computed tomography (CT) and 35% had an X-ray (chest or abdomen). The average time to X-ray was 260 minutes; average time to CT was 324 minutes. Of those patients assessed, 59% had a documented discussion or review by a senior. A digital rectal examination was documented in 24% of patients. 49% of patients had a medical or surgical referral.

After presenting to triage nurses and doctors, we found marked improvements in rates of venous blood gas (100% vs 84%), CRP (100% vs 92%) and amylase (80% vs 64%). Time to X-ray was110 minutes (down from 260), and time to CT was 313 minutes (312). 90% of patients had a senior discussion or review documented (vs 59%), and 30% of patients had a PR (vs 24%).

Abdominal pain in older people is a common presentation to the emergency department, with nearly half of patients requiring referral to either a medical or surgical specialty. Of note, over half of patients underwent CT, yet this formed the main cause of delay. In this population, a high degree of diagnostic uncertainty and a relatively low radiation risk may prompt the question whether CT can be warranted prior to X-ray.

Conclusion

Our quality improvement project has demonstrated that simple teaching for doctors and nurses can improve the rates of important investigations of these patients. We plan to develop a pathway to bring about timely assessment and management for older adults presenting with abdominal pain in the hope of further improving their care.

  • © Royal College of Physicians 2022. All rights reserved.

Reference

  1. ↵
    1. Royal College of Emergency Medicine
    . RCEM Safety Alert. October 2016. https://rcem.ac.uk/safetyalerts
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Assessment of abdominal pain in older people: a quality improvement project in the emergency department
Nur Nurmahomed, Robert Bickerton, Claire Bronze
Future Healthc J Jul 2022, 9 (Suppl 2) 94; DOI: 10.7861/fhj.9-2-s94

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Assessment of abdominal pain in older people: a quality improvement project in the emergency department
Nur Nurmahomed, Robert Bickerton, Claire Bronze
Future Healthc J Jul 2022, 9 (Suppl 2) 94; DOI: 10.7861/fhj.9-2-s94
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Introduction
    • Methods
    • Results and discussion
    • Conclusion
    • Reference
  • Info & Metrics

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Improving the provision and quality of safety netting instructions for patients seen in same-day emergency care (SDEC)
  • The impact of a smoking cessation programme on referrals in a cardiorespiratory admissions unit
  • Improving fluid balance charts through staff education on a general medical ward: a quality improvement project
Show more QUALITY IMPROVEMENT AND PATIENT SAFETY

Similar Articles

FAQs

  • Difficulty logging in.

There is currently no login required to access the journals. Please go to the home page and simply click on the edition that you wish to read. If you are still unable to access the content you require, please let us know through the 'Contact us' page.

  • Can't find the CME questionnaire.

The read-only self-assessment questionnaire (SAQ) can be found after the CME section in each edition of Clinical Medicine. RCP members and fellows (using their login details for the main RCP website) are able to access the full SAQ with answers and are awarded 2 CPD points upon successful (8/10) completion from:  https://cme.rcplondon.ac.uk

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home

Other Services

  • Advertising
futurehosp Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians