PTU-103 Comparative re-audit of novel bleeds rota provision in a large district general hospital

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Abstract

Introduction

Acute upper gastrointestinal bleeding (UGIB) is a common medical emergency with an incidence of 103–172 per 100 000 in the UK. Doncaster and Bassetlaw Hospitals (DBHFT) receives 700–900 admissions with UGIBs annually. Due to an acute shortage of gastroenterologists, DBHFT offers a unique weekend-only service (WOS) operating out-of-hours (OOH) from Friday PM until Monday AM, but no official service delivery on weekdays OOH. This rota was implemented following an initial audit in 2014, when there was no weekend or weekday formalised service provision. The aim of this audit is to identify whether this method is adequate and if it confers a better prognostic outcome for patients.

Methods

198 patients were identified by the audit department by using computer code-based search criteria for random retrospective analysis. Out of 198, the first 100 patients were audited in 2014 (admitted Jan 2012-Jan 2013) and the remaining 98 patients were included in the re-audit in 2017 (admitted Jan-Dec 2016) following initiation of WOS. The end-points of each patient encounter were of those defined in the NICE guidelines.

Results

Demographic information revealed that the male to female ratio in 2014 and 2017 audits was 58:42 and 54:46, respectively. The mean ages in 2014 and 2017 were 66 and 64 years respectively. In 2014, 58% (n=58) of patients had access to OGD within 24 hours of presentation, of which 55% (n=32) had OGD during normal office hours (NOH) on a weekday and 45% (n=26) had OGD within 24 hours if presenting OOH on ad-hoc weekend lists. In 2017, 69% of the patient received OGD within 24 hours of presentation during NOH and 74% of the patients received OGD within 24 hours if presenting OOH. The length of stay (LOS) in 2017 was reduced with 63% of patients discharged within 0–5 days of presentation, with a median LOS of 2 days. Comparatively, in 2014 the median LOS was 5 days. Endoscopic dual therapy was delivered to 12% and single therapy to 7.2% of patients in 2017 audit. On the other hand in 2014, dual and single therapy was administered in 9% and 15% cases, respectively. Finally in 2017, we found that 28% of patients needed a repeat endoscopy due to further bleeding or on-going haemodynamic instability, and a further 4% had an interventional radiology procedure done. There were 3 deaths in this cohort, but this was attributable to other co-morbidity rather than as a direct consequence of UGIB.

Conclusions

This re-audit concludes that in a busy district general hospital with insufficient number of endoscopists to provide a full 24/7 bleeds rota, this novel method of service delivery infers significant improvement in access to endoscopy, reduction in LOS and an improvement in morbidity.

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