Closing the Gaps in Exocrine Pancreatic Insufficiency Care: Improving Diagnosis, Dosing, and Care Transitions - Episode 11
Bridging the Gaps: Care Transitions and Breakdowns in EPI
Clinicians reveal where pancreatic care falls apart—diagnosis delays, post-discharge gaps, lost oncology follow-up—and how to fix handoffs fast.
This episode addresses the practical failures in care coordination that allow EPI to fall through the cracks. Sarah Enslin immediately identifies three critical breakdown points: the initial diagnosis phase (delayed referral from primary care), post-hospitalization transitions (from inpatient to outpatient care following acute or necrotizing pancreatitis), and cancer care transitions (patients diagnosed endoscopically who then enter oncologic care and lose GI follow-up).
Post-surgical patients—those after Whipple procedures, necrosectomies, or other pancreatic or GI surgeries—are particularly at risk. Jennifer Geremia notes that surgeons and interventional endoscopists have transient touchpoints and may not provide long-term follow-up themselves. Making explicit GI follow-up recommendations—with specific names or community referral lists—at discharge is an actionable step. Empowering patients with awareness of their own need for follow-up also adds a layer of self-advocacy.
Dr. Kaul highlights the emergency department as a particularly challenging handoff environment. Chronic pancreatitis patients cycling through the ED—often labeled as drug seekers—represent a missed opportunity for meaningful intervention. Without structured discharge pathways, these patients leave without appropriate outpatient referral. Building structured ED protocols and after-visit summaries that facilitate GI referral is proposed as a quality improvement opportunity.
The panel closes on an optimistic note: larger practices and academic centers have the opportunity to develop dedicated pancreas specialty clinics—modeled on IBD and liver clinics—where intake processes are smoother, handoffs are more deliberate, and multidisciplinary coordination is embedded into clinic design. Leveraging EMR tools like structured handoff sheets and cross-system patient notes also enhances continuity within integrated health systems.
In the next episode, "Evidence in Practice: What a New Prescribing Survey Reveals About EPI Care Gaps," the panel examines a recently published survey on PERT prescribing practices across healthcare professionals, offering a real-world view of how EPI is currently managed—and where gaps persist.
