RT Journal Article
SR Electronic
T1 Improving the management of spontaneous bacterial peritonitis in cirrhotic patients: assessment of an intervention in trainee doctors
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 426
OP 430
DO 10.7861/clinmedicine.15-5-426
VO 15
IS 5
A1 Timothy M Rawson
A1 Sonia Bouri
A1 Christopher Allen
A1 João Ferreira-Martins
A1 Abulkani Yusuf
A1 Nina Stafford
A1 Maxton Pitcher
A1 Meron Jacyna
YR 2015
UL http://www.rcpjournals.org/content/15/5/426.abstract
AB Spontaneous bacterial peritonitis (SBP) in cirrhotic patients is a serious complication associated with a high mortality rate. A baseline audit of the acute medical take (AMT) at Northwick Park suggested a lack of awareness regarding management. A questionnaire based on contemporary SBP guidelines was circulated to all trainee doctors (FY1 to SpR). Ascitic fluid testing requests were analysed over a six-month period. The electronic requesting system was updated to include prompts and direct links to Trust SBP guidelines, and a one-hour lecture to all members of the AMT, supported by an educational booklet on SBP, was performed. Re-audit was carried out six months post-intervention, the AMT completed a second questionnaire and ascitic fluid testing requests were re-audited. In comparable pre- and post-intervention AMT cohorts, a clinical and educational intervention led to a significant improvement in understanding of when to investigate (p≤0.001), samples (p = 0.002) and containers (p≤0.001) required, urgency of obtaining results (p≤0.001), and initiation of treatment for suspected SBP (p = 0.007). Significantly more ascitic samples were sent, with specific suspicion of SBP more readily documented, crucial to expediting laboratory processing. Targeted education and production of a clinical algorithm has significantly improved the management of patients with SBP.