{
  "abstract": "Introduction Timely access to endoscopic retrograde cholangiopancreatography (ERCP) is essential for patients with biliary obstruction and acute cholangitis. UK guidance from organisations including the British Society of Gastroenterology (BSG) and Joint Advisory Group on GI Endoscopy (JAG) recommends urgent ERCP within 72 hours. Patients often undergo multiple imaging modalities prior to ERCP which can impact timeliness and create delays. Local experience suggested that delays to ERCP were common despite five day procedural capacity. This project aimed to assess compliance with the 72 hour target and map bottlenecks within the inpatient ERCP pathway to identify targets for intervention.Methods A service evaluation was undertaken at a University Teaching Hospital. Consecutive adult inpatients referred for ERCP over a 6-week period were included; outpatient procedures were excluded. Key timepoints from admission to ERCP were recorded. These included: initial imaging, final imaging, ERCP request, booking, and procedure date. The primary outcome was time from admission to ERCP. Secondary outcomes included time to first & final imaging and time from imaging completion to ERCP request.The units of ‘total days’ were manually crossed checked with ‘working hours’ to ensure the validity of assessment metrics. Delays in the patient ERCP pathways was visualised with Gantt charts.Results Twenty-four inpatient ERCP referrals were analysed. Mean time from admission to ERCP was 9.0 days, substantially exceeding the 72-hour UK target for urgent ERCP. Time to first imaging modality averaged 1.6 days, increasing to 3.3 days for final imaging. Radiology related delays were rooted in waits for imaging requesting rather than performing or reporting.ERCP was requested an average of 5.5 days after admission, with a 2.1-day delay between final imaging and ERCP request, accounting for approximately one-third of the total wait. MRCP was performed in 22/24 patients. All patients who underwent MRCP waited for a formal report prior to ERCP request, despite the majority having clear indications for ERCP on initial imaging, this added an average of 4.9 days to the delay to ERCPERCPs were performed, on average, 3.5 days after being requested and booked.Conclusion Inpatient ERCP delivery at our centre falls significantly outside BAG / JAG standards. Whilst ERCP capacity is contributing to delays, long waits are driven predominantly by upstream factors such as imaging sequencing and referral processes. These findings suggest that increasing ERCP list capacity alone is unlikely to achieve meaningful improvements in timeliness. Removing the requirement for MRCP prior to ERCP requesting in cases when the diagnosis and indication for ERCP is clear could have a substantial impact on service delays.Abstract P281 Figure 1Cumulative gantt chart representing individual and average ERCP delays",
  "authors": [
    {
      "affiliations": [
        "University Hospital Wales, Cardiff, United Kingdom"
      ],
      "name": "Oliver Mitchell"
    },
    {
      "affiliations": [
        "University Hospital Wales, Cardiff, United Kingdom"
      ],
      "name": "Tom Pembroke"
    }
  ],
  "title": "P281 Would increasing capacity improve timeliness of inpatient ERCP? Mapping inpatient delays within an inpatient ERCP pathway",
  "uid": "02760559-dbf7-58eb-a5d3-cbbe86fe0cc7"
}