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PWE-128 The Out-of-Hours Gastrointestinal Bleed Service in South-West London: A Model for Regional Emergency Endoscopy Cover
  1. C Alexakis1,
  2. V Chhaya2,
  3. I Sutherland2,
  4. R Lalani2,
  5. O Tavabie3,
  6. R Hewett1,
  7. D Chan1,
  8. G Amarasinghe1,
  9. J Ryan1,
  10. S Uppal1,
  11. N Inayet1,
  12. C Woodhouse1,
  13. B Kok1,
  14. G Chakrabarty1,
  15. S Moodie2,
  16. P Patel2,
  17. S Zar2,4,
  18. A Mahmood2,
  19. G Sadler1,
  20. C Groves1,
  21. S Gupta3,
  22. S Clark1
  1. 1Gastroenterology, St George’s NHS Trust, London
  2. 2Gastroenterology, Epsom and St Helier’s NHS Trust, Surrey
  3. 3Gastroenterology, Croydon University Hospital NHS Trust, London
  4. 4Gastroenterology, Royal Marsden Hospital, Sutton, UK

Abstract

Introduction Gastrointestinal (GI) bleeding is associated with a mortality of 10–30%. An NCEPOD report recently recommended that management of GI bleeds should be directed by a named GI bleed clinician, although wasn’t implicit that procedures be performed by a consultant.1 In SW London, 5 hospitals developed a network service to cover out-of-hours emergency endoscopy requirements for the region. It is a registrar-delivered, consultant-supported service. We present the key service outputs over a 10 month period in 2015.

Methods OGDs were performed by registrars accredited with appropriate skills in upper endoscopy. Endoscopists prospectively collected data on all out-of-hours OGDs performed including age and sex of patient, Rockall score, time to OGD, primary endoscopic findings and therapeutic intervention. Data on mortality and re-bleed rates were retrospectively collected for the last 2 months of the study.

Results 172 out-of-hours OGDs were performed between March and December 2015. 57% occured during the weekend, giving rise to a procedure rate of 1.12 OGD/weekend day and 0.33 OGD/week day. Mean age of patient was 59.5 years (range 16–94). 64% were male. Median Rockall score was 4. Mean time to OGD was 4hrs 15 mins (range 1 hr-16hrs). Table 1 shows the primary pathologies at OGD. Therapeutic intervention was needed in 52% of cases. Failure to achieve haemostasis endoscopically occured in 1.7%. Consultant assistance was required in 3 cases. Data from Nov to Dec 2015, which included 40 OGDs (mean age 59 years, 63% males, intervention rate 53%) indicated an inpatient re-bleed rate of 10% (NCEPOD audit rate 23%), an interventional radiology requirement in 6% (NCEPOD 8%) and a surgical intervention rate of 2.5% (NCEPOD 6%). All-cause 30 day mortality rate was 15%, although only one patient (2.5%) died as a direct result of uncontrolled bleeding.

Abstract PWE-128 Table 1

Conclusion The results indicate that an effective and safe regional out-of-hours emergency GI bleed service can be provided via a registrar-delivered, consultant-supported model. This has important implications when considering the development of consultant on-call rosters, and maximising training opportunities for registrars.

Reference 1 NCEPOD ‘Time to get control’ – a review of the care received by patients who had a severe gastrointestinal haemorrhage 2015.

Disclosure of Interest None Declared

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