Streamlining the Non-operative Management of Adhesive Small Bowel Obstruction: A Closed-Loop Audit Evaluating the Introduction of a Standardised Gastrografin Protocol in a District General Hospital.

Introduction Adhesive small bowel obstruction (ASBO) is a common cause of admissions to general surgery services. Water-soluble contrast (WSC), such as Gastrografin® (GGF), can be utilised in the conservative management of patients with ASBO, with predictive and possible therapeutic value. We audited the non-operative management of ASBO in the general surgery department of East and North Hertfordshire NHS Trust, a district general hospital. Following the introduction of a hospital-wide protocol standardising the use of GGF in patients with ASBO, a re-audit was conducted to assess its impact. Methods A retrospective audit of ASBO patients who received GGF was conducted in two cycles: before and after the implementation of the protocol. Data were collected between February and June 2022 for group 1 (pre-protocol) and between August and November 2023 for group 2 (post-protocol). Results Forty-eight patients were included in the analysis across both groups: 31 in group 1 (pre-protocol) and 17 in group 2 (post-protocol). The success rate of this non-operative trial with GGF increased from 77% (24/31) in group 1 to 88% (15/17) in group 2. The median duration of conservative management was two days in both groups. The median time from CT scan to GGF administration decreased from 24 hours in group 1 to 19 hours 22 minutes in group 2, and the interval between GGF administration and first abdominal radiograph decreased from 9 hours in group 1 to 6 hours 25 minutes in group 2. Conclusion Our closed-loop audit suggests that by streamlining the non-operative management pathway of adhesive small bowel obstruction, our standardised protocol is safe and possibly improves efficiency within a district general hospital setting.