Quality standard
Quality statement 3: Emergency endoscopic retrograde cholangiopancreatography within 24 hours
Quality statement 3: Emergency endoscopic retrograde cholangiopancreatography within 24 hours
Quality statement
Adults with common bile duct stones who need emergency endoscopic retrograde cholangiopancreatography have it within 24 hours.
Rationale
Endoscopic retrograde cholangiopancreatography can be used to treat common bile duct stones. Not everybody will need this procedure within 24 hours, but emergency endoscopic retrograde cholangiopancreatography can improve outcomes for adults with acute cholangitis or acute pancreatitis if their condition is not responding to antibiotics or intravenous fluids. Delaying endoscopic retrograde cholangiopancreatography for adults with these conditions risks complications such as sepsis.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that adults with common bile duct stones who need emergency endoscopic retrograde cholangiopancreatography have it within 24 hours.
Data source: Local data collection.
Process
Proportion of adults with common bile duct stones who need emergency endoscopic retrograde cholangiopancreatography who have it within 24 hours.
Numerator – the number in the denominator who have endoscopic retrograde cholangiopancreatography within 24 hours.
Denominator – the number of adults with common bile duct stones who need emergency endoscopic retrograde cholangiopancreatography.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (such as secondary care services) ensure that healthcare professionals are trained to perform endoscopic retrograde cholangiopancreatography, and that adults with common bile duct stones who need this procedure in an emergency can have it within 24 hours. For 24‑hour endoscopic retrograde cholangiopancreatography, service providers may need to be aware of local networks.
Healthcare professionals (such as gastroenterologists, radiologists and upper gastrointestinal surgeons) are trained to perform endoscopic retrograde cholangiopancreatography, and provide it for adults with common bile duct stones who need it in an emergency within 24 hours.
Commissioners monitor services that offer endoscopic retrograde cholangiopancreatography to ensure that they regularly perform it, and that adults with common bile duct stones can have it as an emergency within 24 hours if needed.
Adults with common bile duct stones are able to have an endoscopy (inserting a thin, flexible tube down their throat to perform surgery inside their body) within 24 hours if they need it in an emergency. The endoscopy is to remove the stones in their bile duct (part of the digestive system that is connected to the gallbladder) and prevent other problems such as blockages, inflammation or infection.
Source guidance
Gallstone disease. NICE guideline CG188 (2014), recommendation 1.3.2 (key priority for implementation) and expert consensus
Definitions of terms used in this quality statement
Emergency endoscopic retrograde cholangiopancreatography
Emergency endoscopic retrograde cholangiopancreatography (within 24 hours) is needed for adults with common bile duct stones and acute cholangitis or acute pancreatitis when indicated. [Adapted from NICE's guideline on gallstone disease, recommendations 1.3.1 and 1.3.2]