Background Traditionally, lower GI bleeding (LGIB) is admitted surgically but the recent NCEPOD report has recommended an integrated pathway for all gastrointestinal bleeds.
Aim To retrospectively assess how LGIB is managed within the Trust.
Method Inpatient discharge data were gathered over a 12 month period (March 2015-March 2016). Cases included were those with LGIB as the primary reason for admission. Factors including length of stay, inpatient and/or outpatient endoscopic and radiological investigations. 30 day mortality rate was assessed.
Results 350 patients were identified, 174 were excluded (UGIB or not primary reason for admission). 176 patients were included, age range 17–100 (median 66). Median length of stay=3.19 days (range 0–27). Total bed days 562. 30 day mortality=3.9% (n=7, 2 secondary to PR bleeding and 5 due to co-morbidities). n=86 (48.9%) patients had inpatient investigations. See Figure 1.
50 patients had only inpatient endoscopic procedures, 15 had both endoscopic and radiological investigations and 15 had only radiological investigations. Others included EUA and haemorrhoidectomy. n=46 (26.1%) had only outpatient investigations. Total bed days=83. n=44 (25%) had no investigations. Reasons included known pathology, recent endoscopy or CT imaging, recent intervention (surgical or endoscopic) or not fit for investigation. Most common diagnoses were diverticular bleed n=59, haemorrhoids n=12, malignancy n=10.
Conclusions Less than half had inpatient investigations suggesting that many admissions could have been avoided. The current results show a low mortality rate consistent with other published data. A pathway for the management of stable LGIB bleeding could be developed to minimise unnecessary admissions and streamline access to intervention where needed.
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