Best‐practice care pathway for improving management of mastitis and breast abscess

• Published in: British journal of surgery 2018-11, Vol.105 (12), p.1615-1622
• Main Authors: Patani, N., MacAskill, F., Eshelby, S., Omar, A., Kaura, A., Contractor, K., Thiruchelvam, P., Curtis, S., Main, J., Cunningham, D., Hogben, K., Al‐Mufti, R., Hadjiminas, D. J., Leff, D. R.
• Format: Article
• Language: English
• Subjects: Abscess - diagnostic imaging; Abscess - therapy; Aftercare - statistics & numerical data; Anti-Bacterial Agents - therapeutic use; Antibiotics; Breast cancer; Breast Diseases - diagnostic imaging; Breast Diseases - therapy; Breasts; Clinical Protocols; Critical Pathways; Disease management; Drainage - methods; Female; Guideline Adherence; Hospitalization - statistics & numerical data; Humans; Length of Stay; Mastitis - diagnostic imaging; Mastitis - therapy; Practice Guidelines as Topic; Practice Patterns, Physicians' - standards; Retrospective Studies; Ultrasonic imaging; Ultrasonography, Mammary
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.10919

Background Surgical subspecialization has resulted in mastitis and breast abscesses being managed with unnecessary admission to hospital, prolonged inpatient stay, variable antibiotic prescribing, incision and drainage rather than percutaneous aspiration, and loss to specialist follow‐up. The objective was to evaluate a best‐practice algorithm with the aim of improving management of mastitis and breast abscesses across a multisite NHS Trust. The focus was on uniformity of antibiotic prescribing, ultrasound assessment, admission rates, length of hospital stay, intervention by aspiration or incision and drainage, and specialist follow‐up. Methods Management was initially evaluated in a retrospective cohort (phase I) and subsequently compared with that in two prospective cohorts after introduction of a breast abscess and mastitis pathway. One prospective cohort was analysed immediately after introduction of the pathway (phase II), and the second was used to assess the sustainability of the quality improvements (phase III). The overall impact of the pathway was assessed by comparing data from phase I with combined data from phases II and III; results from phases II and III were compared to judge sustainability. Results Fifty‐three patients were included in phase I, 61 in phase II and 80 in phase III. The management pathway and referral pro forma improved compliance with antibiotic guidelines from 34 per cent to 58·2 per cent overall (phases II and III) after implementation (P = 0·003). The improvement was maintained between phases II and III (54 and 61 per cent respectively; P = 0·684). Ultrasound assessment increased from 38 to 77·3 per cent overall (P