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Service development I
PMO-006 Out of hours gastrointestinal bleed service in the UK: inter-hospital transfer of patients for endoscopy is safe
  1. B N Shokouhi,
  2. M Khan,
  3. S Greenfield
  1. Department of Gastroenterology, Queen Elizabeth II Hospital, Hertfordshire, UK

Abstract

Introduction Acute Upper Gastrointestinal Bleeding (AUGIB) results in 25 000 in-patient admissions annually in the UK (1). Patients admitted at weekends with AUGIB have significantly increased mortality (2). Current guidelines advise availability of out-of-hours (OOH) endoscopy (3). We present data from our service in the UK involving inter-hospital transfer of patients.

Methods We pooled resources of two neighbouring general hospitals, just North of London: Emergency endoscopy is performed at start of the list followed by elective endoscopy in the endoscopy unit on Saturday and Sunday morning. From Friday evening until Sunday morning, patients admitted to Queen Elizabeth II (QEII) Hospital are medically stabilised and transferred to Lister Hospital by ambulance (13 miles apart, fast freeway).

Results A total of 240 endoscopies were performed OOH from December 2007 to March 2011. Of these, 54 patients were transferred: nine had emergency endoscopy at QEII as they were medically unstable; eight of the patients transferred required therapeutic intervention for active bleeding. The mean pre-endoscopy Rockall score of those transferred was 2.5 (range 0–6). We examined the medical records of 51 (of 54) of the patients transferred. There were three deaths within 30 days of endoscopy, but these were not associated with the transfer process. A total of 19 (37%) of patients had reduced hospitalisation after having their endoscopy at the weekend, as opposed to waiting for endoscopy on Monday.

Conclusion The introduction of the OOH endoscopy service has had multiple benefits.

  • Patients consistently receive timely emergency endoscopy.

  • Patients may be discharged earlier once they have had the endoscopy.

  • There is significantly reduced disruption to emergency operating theatres.

  • Participation of endoscopy nurses ensures a better and safer experience for the patients, and better endoscopy decontamination.

  • Routine elective weekend endoscopy has reduced waiting lists and generated revenue for the hospitals, justifying the cost of setting up the service.

We suggest that our model is safe and it is feasible for other small units wishing to set up their own OOH endoscopy service to adopt.

Abstract PMO-006 Table 1

Breakdown of endoscopies performed December 2007–March 2011

Competing interests None declared.

References 1. Palmer KR. Haematemesis and melaena. Postgrad Med J 2003;31:19–24.

2. Shaheen AA, et al. Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease. Clin Gastroenterol Hepatol 2009;7:303–10.

3. British Society of Gastroenterology Endoscopy Committee. Non-variceal upper gastrointestinal haemorrhage: guidelines. Gut 2002;51(Suppl IV):iv1e6.

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