Journal Article

P295 A change in lower gastrointestinal bleeding pathways, investigations, but not outcomes with COVID-19 and the loss of level 2 beds

Jacunski, Mark, Mehta, Aditya, Moroni, Francesca, Siddhi, Sandeep

2023

Overview

IntroductionMost patients with acute lower gastrointestinal bleeding (LGIB) requiring admission to the Aberdeen Royal Infirmary (ARI) are managed under gastroenterology. Before the COVID-19 pandemic, escalation of care was largely to the Medical High Dependency Unit (MHDU), but at the onset of the pandemic, MHDU beds were absorbed into the intensive treatment unit (ITU) as part of critical care re-organisation. In the absence of a validated severity score for LGIB, we retrospectively reviewed patient pathways and survival to understand the impact of critical care restructuring.MethodsAn electronic patient record search over 10 months before and after 31/03/2020, respectively termed ‘pre-pandemic’ and ‘pandemic’, identified unscheduled admissions to ARI with discharge summaries coded with LGIB or unspecified GIB. We used discharge summaries and investigation reports to identify patients with LGIB that warranted investigation or management. Patient demographics, investigations, admitting ward, and outcome were analysed with statistical testing by chi-squared, Wilcoxon rank sum, and general linear models.ResultsThe audit identified 279 admissions, comprising 263 unique patients, with 141 pre-pandemic admissions (50.5%) and 138 admissions (49.5%) in the pandemic timeframe. There were no significant differences in sex, age, or managing specialty between timeframes. No pre-pandemic patients were admitted to ITU and similarly in the pandemic timeframe, no patients were admitted to MHDU. of pre-pandemic admissions, 22 (17%) were admitted to MHDU; of pandemic admissions, 8 (7%) were admitted to ITU. There was a non-statistically significant decrease in lower gastrointestinal endoscopy (40% vs 30%). There were no statistically significant changes in computed tomography mesenteric angiograms, reliance on outpatient investigations or length of stay. Decreased survival at 30 days was associated with documented shock, but not timeframe or critical care setting.ConclusionsPatients with LGIB admitted to the ARI in the 10-month periods before and after 31/03/2020 may have experienced different care due to critical care reorganisation, rapidly increased staffing pressures, and disinclination to perform endoscopy due to concerns about faecal viral shedding relating to the COVID-19 pandemic. Indeed, admission to critical care decreased to less than half of pre-pandemic levels. Despite this, admitting specialties, investigations performed, length of stay, and survival did not significantly change. This suggests that major outcomes are not affected by managing all but the most critically ill patients with LGIB at ward level.

• Publisher: BMJ Publishing Group LTD
• Subject: Bleeding / Computed tomography / COVID-19 / Critical care / Endoscopy / Gastroenterology / Length of stay / Pandemics / Patients / Statistical analysis / Survival