AN ASSESSMENT OF THE COMPLIANCE WITH THE UPPER GASTROINTESTINAL BLEED CARE BUNDLE IN AN INPATIENT SETTING WITH DAILY ENDOSCOPY LISTS

Aims To assess whether the British Society of Gastroenterology Upper Gastrointestinal Bleed (UGIB) bundle [1] was being followed in a centre with access to emergency endoscopy lists between monday-friday.

Methods We reviewed notes of all patients referred as an UGIB who proceeded to endoscopy between August 2020-February 2021. 113 patients were identified, of these 8 had a background of cirrhosis. We collected data attaining to each recommendation in the care bundle, including time to endoscopy, whether a Glasgow-Blatchford score (GBS) was calculated, whether intravenous fluids (IVF) and blood products were given, whether cirrhotic patients received antibiotics and terlipressin and, if a treatment was given, at least 2 methods of haemostasis were applied.

Results Average time from referral to endoscopy was 23.6 hours. 58% of patients underwent endoscopy within 24 hours of referral. Of patients admitted over the weekend, average time to scope was 38 hours. All patients with Hb<70 received blood transfusion. 21 patients had endoscopic therapy, 12 had at least dual therapy. GBS was calculated for 42% of patients. 68% were given IVF (in 2 patients it was considered contraindicated due to comorbidities). Of the cirrhotic patients, 57% were given terlipressin and antibiotics.

Conclusions In a centre with accessible emergency endoscopy lists, we are able to comply with the UGIB care bundle guidance on timing of endoscopy. Significant delays in endoscopy were identified for patients presenting over the weekend. Compliance with other aspects of the care bundle was variable and leaves scope for further education to optimise patient outcomes.

Publication History

Article published online:
14 April 2022