Introduction BSG and NICE guidelines recommend that all patients with a suspected GI bleed have an endoscopy within 24 hours of admission. The Queen Elizabeth Hospital (QEH), Gateshead (a District General Hospital serving a population of approximately 200,000) provides an urgent out of hours GI bleed service. Additionally there is an 8.30am slot in endoscopy from Monday to Friday allocated to patients who have symptoms of an upper GI bleed. We audited our compliance to the 24 hour guideline.
Methods The electronic reporting system ‘Endosoft’ was searched using the terms: Upper GI bleed; Malaena; or Haematemesis, for all referrals for gastroscopy between January 1st 2011 and December 31st 2011. The date, time of endoscopy, findings and interventions were noted. Time of admission, theatre use and In-patient and 4 week mortality were also noted.
Results 162 patients were admitted with acute GI bleeding over the 12 month period. Overall 126 (78%) were endoscoped within 24 hours. 35 of the 36 patients endoscoped in theatre had their procedure within 24 hours of admission. 16 (44%) of the 36 patients outside the 24 hour window were admitted on a Friday evening or Saturday. Of the 36 patients that suffered a delay to endoscopy: 5 had oesophageal varices; 1 a gastric varix; 6 peptic ulcer disease (4 high risk stigmata and 2 low risk); 2 Mallory Weiss tear, and 22 were normal. Of the 36 patients who went straight to theatre, 34 (94%) had an endoscopic cause for bleeding identified. 20 (56%) had variceal bleeds, 12 had peptic ulcer disease (10 high risk stigmata and 2 low risk). Overall in-patient mortality of those found to have an upper GI cause for bleeding was 16% (15 of 91) and 4 week mortality was 18% (17 of 91). Five (29%) of those that died were cirrhotic patients and 8 (47%) had peptic ulcer disease with high risk stigmata. 3 of the 17 deaths occurred in the patients who were delayed prior to endoscopy, one of whom came in at a time when there was no allocated 8.30am slot the following morning. All 3 of the mortalities who waited over 24 hours for their procedure had endoscopic intervention. There was however no significant difference (chi-square test) between mortality of the delayed patients and those scoped within 24hrs (8% compared to 11%).
Conclusion During 2011 the QEH appropriately identified sick patients suitable for the out of hours GI bleed service, with 94% of theatre cases requiring endoscopic intervention. The NICE and BSG guidelines of endoscoping patients referred for a GI bleed within 24 hours of admission was met in 78% of cases. Allocated 8.30am endoscopy slots on Saturday and Sunday would improve these figures, but it is currently unclear if this would affect the patient outcome.
Disclosure of Interest None Declared.
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