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BACKGROUND We introduced an inpatient pancreatitis consultative service aimed to 1) provide guideline-based recommendations to acute pancreatitis inpatients and 2) educate inpatient teams on best practices for acute pancreatitis management. We assessed the impact of pancreatitis service on acute pancreatitis outcomes. METHODS Inpatients with acute pancreatitis (2008-2018) were included in this cohort study. Primary outcomes included length of stay and refeeding time. The educational intervention was a guideline-based decision support tool, reinforced at hospital-wide educational forums. In Part A (n = 965), we compared outcomes pre-service (2008-2010) to post-service (2012-2018), excluding 2011, when the pancreatitis service was introduced. In Part B (n = 720, 2012-2018), we divided patients into 2 groups based on if co-managed with the pancreatitis service, and compared outcomes, including subgroup analysis based on severity, focusing on mild acute pancreatitis. RESULTS In Part A, for mild acute pancreatitis, length of stay (111 vs 88.4 h, P = .001), refeeding time (61.8 vs 47.4 h, P = .002), and infections (10.0% vs 1.87%, P < .001) were significantly improved after the pancreatitis service was introduced, with multivariable analysis showing reduced length of stay (odds ratio 0.83; 95% confidence interval, 0.82-0.84; P < .001) and refeeding time (odds ratio 0.75; 95% confidence interval, 0.74-0.77; P < .001). In Part B, for mild acute pancreatitis, refeeding time (44.2 vs 50.3 h, P = .123) and infections (5.58% vs 4.70%, P = .80) were similar in patients cared for without and with the service. Length of stay was higher in the pancreatitis service group (93.3 vs 81.2 h, P = .05), as they saw more gallstone acute pancreatitis patients who had greater length of stay and magnetic resonance cholangiopancreatography. In the post-service period, a majority of patients with moderate/severe acute pancreatitis and nearly all intensive care unit admits received care from the pancreatitis service. CONCLUSIONS Implementation of an inpatient pancreatitis service was associated with improved outcomes in mild acute pancreatitis. Guideline-based educational interventions have a beneficial impact on management of mild acute pancreatitis by admitting teams even without pancreatitis consultation.

INTRODUCTION: Although the typical presentation of COVID-19 infection includes fever and respiratory complaints, gastrointestinal (GI) symptoms are also common at the time of diagnosis Case-series mainly from eastern Asia have reported varying frequency of GI symptoms in COVID-19 patients Given the regional variations in manifestation of disease, we sought to analyze the prevalence and characterization of gastrointestinal symptoms in COVID-19 patients in the northeastern region of the United States METHODS: We identified and analyzed all patients who underwent COVID-19 testing at our institution between January and March of 2020 Those patients who were hospitalized and confirmed to have COVID-19 infection served as the cases Patients during the same time period who tested negative for COVID-19 served as controls Detailed information, including patient demographics, presenting complaints, diagnostic testing, hospital course, and outcomes, was collected We categorized GI symptoms to include nausea, vomiting, diarrhea, abdominal pain, red blood per rectum, melena, loss of appetite, and loss of taste RESULTS: Out of 307 hospitalized patients who were tested for COVID-19 at our institution, 139 patients tested positive for COVID-19 infection, and 131 patients tested negative for COVID-19 The remaining 37 patients were excluded due to inconclusive or incomplete results Diarrhea (25 2%, OR = 2 4) and loss of appetite (25 9%, OR = 3 2) were the most common GI symptoms in COVID-19 patients, and both were significantly more common when compared to the patients in the control group [Table 1] Other GI symptoms including nausea, vomiting, and abdominal pain were present in 10-20% of COVID-19 patients Isolated gastrointestinal symptoms without the presence of respiratory symptoms occurred in 7 2% of COVID-19 patients at time of diagnosis New-onset GI symptoms after admission were noted in 17 4% of COVID-19 patients There was no significant association between the presence of GI symptoms and disease severity CONCLUSION: Diarrhea and loss of appetite were the most common presenting GI symptoms in patients diagnosed with COVID-19 infection when compared to the control group About 7% of COVID-19 positive patients presented with isolated GI symptoms alone New-onset of GI symptoms developed during admission in 17% of COVID-19 patients The presence of GI symptoms does not appear to be an independent predictor of severe disease or the need for ICU admission

INTRODUCTION: Recent studies from China reported have reported various rates of abnormal liver function tests in patients hospitalized with COVID-19 infection However, data from the United States is limited We sought to evaluate abnormalities in liver function tests (LFTs) in patients presenting with COVID-19 in the United States and compared them to a control group of hospitalized patients tested negative for COVID-19 METHODS: Patients with confirmed COVID-19 infection at our institution between January and March of 2020 were included Patients who were suspected to have COVID-19 but tested negative served as controls Information regarding patient demographics and laboratory values was recorded RESULTS: A total of 139 patients with COVID-19 and 131 were controls were included There was no difference between COVID-19 patients and controls in age (67 4 years versus 67 8 years, P=0 8) or gender (female: 46% versus 59 4%, P=0 5) Upon presentation, LFTs were abnormal in 44 9% of COVID patients compared to 35 8% controls (P=0 12) There was no difference in the proportion of patients with elevated total bilirubin and international normalized ratio (INR) among COVID patients and controls A higher proportion of COVID patients than controls had abnormal serum Alanine Aminotransferase (ALT) (27 9% versus 16 5%, P=0 02) and serum Aspartate Aminotransferase (AST) levels (41 8% versus 22 1%, P