Title : Benchmarking paediatric appendicitis care against GIRFT standards: A single-centre audit
Abstract:
Aim: To assess compliance with Getting It Right First Time (GIRFT) best-practice standards for paediatric appendicitis at Norfolk and Norwich University Hospital and compare local negative appendicectomy and readmission rates with national benchmarks.
Methods: A six-month retrospective audit was undertaken of children aged 0–16 years undergoing appendicectomy. Compliance was assessed against 17 GIRFT-derived standards covering clinical assessment, analgesia, imaging, multidisciplinary review, timing of surgery, antimicrobial stewardship, intraoperative sampling and postoperative outcomes. A separate three-year appendicectomy dataset was analysed to evaluate appendicitis related readmission. Local negative appendicectomy and readmission proportions were compared with published national benchmark rates using two-sided exact binomial tests. Statistical significance was defined as p<0.05.
Results: Fifty-three appendicectomies were included in the six-month audit, with full compliance achieved for 15 of 17 standards. No appendicitis related readmissions occurred in this cohort (0/53). Across the separate three-year dataset, 8/275 patients were readmitted (2.9%), compared with the national benchmark of 9.7% (p<0.05). The negative appendicectomy rate was 1/53 (1.9%), compared with the national average of 6.1% (p>0.05). Areas requiring improvement were compliance with recommendations regarding peritoneal swab sampling and appendicectomy within 24 hours of admission.
Conclusion: Compliance with GIRFT paediatric appendicitis standards was high, with local negative appendicectomy and readmission rates below national benchmarks. Improvement measures should focus on timely surgery and appropriate peritoneal swab use. Following departmental education and pathway reinforcement, re-audit is planned to assess compliance with all 17 standards and complete the audit cycle.
