PTH-050 The Impact of a Dedicated Inpatient Bleeders Endoscopy List in the Timely Management of Acute Upper Gastrointestinal Bleeds

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Abstract

Introduction

Acute upper gastrointestinal bleeding (AUGIB) is still a medical emergency with a hospital mortality rate of 10%[1]. NICE guidelines recommend that endoscopy is offered to all patients presenting with AUGIB within 24 h[1]. In order to improve our waiting times, a week day dedicated Inpatient Bleeders (IB) list was introduced from October 2012 and its impact on time to endoscopy and length of hospital stay monitored through audit.

Methods

A retrospective audit of all AUGIB in Princess Alexandra Hospital (a district general hospital in Essex) was conducted from April-September 2012 (prior to the introduction of the IB list) and from January-April 2013 (once IB list established). The IB list set aside 3 slots every Monday-Friday from 8–9 am for inpatient AUGIB. Each week a designated consultant gastroenterologist was responsible for performing endoscopies on the IB list. AUGIB cases were identified from endoscopy indications being ‘haematemesis’ and/or ‘melaena’. Patients who developed AUGIB after admission were excluded. For each patient, the endoscopy date, admission and discharge dates were collected from electronic discharge summaries and patient records. The time (in days) to endoscopy (from admission) and length of hospital stay (LOS) was calculated for all cases.

Results

The longest wait to OGD was for patients admitted on a weekend (Friday-Sunday) with a mean waiting time of 3.04 days pre IB list though this figure reduced to 1.88 days with the introduction of the IB list.

Conclusion

The introduction of the 5 day IB list enabled our gastroenterology service to improve compliance with the NICE guidelines for AUGIB as the mean number of days to OGD decreased from 2.15 to 1.78, with over 50% of patients having an OGD within 24 h under the new system. The median LOS was also reduced from 5 to 4 days with the IB list. We expect that an extension of the IB list from a 5 to 7 day service would further reduce waiting times to OGD and LOS. The use of a dedicated ‘bleeders’ list prior to the start of elective endoscopy lists is an efficient and safe method of meeting targets in AUGIB and we would recommend its use particularly in a district general hospital setting with limited access to a 24/7 emergency AUGIB endoscopy service.

Reference

1Acute upper gastrointestinal bleeding: management’; Issued June 2012; NICE clinical guidance 141; guidance.nice.org.uk/cg141

Disclosure of Interest

None Declared.

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