eP598 - Enhancing the Colorectal Fellowship Program with a Curriculum-based Critical Care Rotation: The Philippine General Hospital Framework

Purpose/Background: Approximately 9% of colorectal surgery patients require critical care support after either elective or emergency procedures. Similarly, critically ill patients may need colorectal surgery on some occasions. It is necessary that physicians handling these patients are knowledgeable and equipped to achieve the best outcomes for them. In the Philippines, there are 11 training programs for colorectal surgery, however, none of these have formally included critical care in their curriculum. We deem it vital to incorporate critical care training to colorectal surgery fellowship programs as this will positively impact the management of colorectal patients.Methods/Interventions: A review of records was conducted at the Philippine General Hospital (PGH), a tertiary government end referral center, from January 2023 to September 2023. This included a tally of patients admitted under the Division of Colorectal Surgery, those patients referred to the Division of Surgical Intensive Care, and the actual number of patients admitted to the Surgical Intensive Care Unit (SICU).Once the actual gravity of the situation was assessed, a curriculum of the critical care rotation was developed based on the reasons for referral and causes of mortality. A training module was written based on the most recent recommendations and evidence.Results/Outcomes: The Division of Colorectal Surgery at the PGH is currently composed of 10 consultants and 2 fellows-in-training. Meanwhile, the Division of Surgical Intensive Care has 5 consultants, and 1 fellow-in-training.For this year alone, the Division of Colorectal Surgery had a total of 701 admissions. Almost 6% required co-management with the Surgical Intensive Care, however, only a third of these patients were actually accommodated in the SICU. The current SICU can only accommodate 7 patients at a time due to logistic and personnel limitations.The documented reasons for referral to the Critical Care service include: septic shock/sepsis, acute respiratory failure, myocardial infarction, acute kidney injury, tumor rupture, disseminated intravascular coagulation, acute liver failure, open abdomen, and post-operative monitoring after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Mortality rate of these patients was noted at 56.4%, with septic shock and acute respiratory failure as the top causes of death.The curriculum includes modules on the following: a) Sepsis guidelines and the obstructed patient, b) Surgical nutrition, c) Perioperative resuscitation, d) Fluids and electrolytes, e) Open and hostile abdomen, f) Abdominal compartment syndrome, g) Care for CRS-HIPEC patients, and h) Proper use of pressors.The rotation will be required for first year colorectal fellows-in-training during the latter half of the year. They are expected to actively manage their patients with a critical care consultant, and are required to attend the weekly division conferences and lectures. At the end of the rotation, they will be asked to evaluate the curriculum based on knowledge and confidence acquired. Feedback for the improvement of the rotation will be assessed for possible inclusion in the module.Conclusion/

Discussion: Integration of intensive care in colorectal surgery training is imperative, more so in resource-limited settings. Fellows-in-training become adept in managing patients in need of critical care despite logistical concerns. Ultimately, the goal of this additional training is to provide patients with the best quality of care to result in best possible outcomes.Table 1Number of total admissions under the Division of Colorectal Surgery, number of patients referred to the Division of Surgical Intensive Care for co-management, the number of actual admissions to the Surgical Intensive Care Unit, and the mortality rates. (PGH, January to September 2023)