Journal Article

P153 Introducing the british society of gastroenterology acute upper GI bleed bundle into hospital practice

Wetten, Aaron, Rowell, Matthew, Bragg, Rebecca

2023

Overview

IntroductionAcute upper gastrointestinal bleeding (AUGIB) has an annual incidence of 134 per 100,000, with an overall mortality of 10%. The nature of AUGIB can result in high pressured situations. Prompt and appropriate initial treatment can determine outcomes. Care bundles have been shown to improve standards of care as seen in the decompensated cirrhosis bundle. The British Society of Gastroenterology (BSG) introduced the AUGIB bundle in 2018 to improve the standard of care; however, it is less widely adopted into practice than the decompensated bundle. We reviewed current practice in a single North East NHS trust, in the management of AUGIB before and after introducing the BSG AUGIB bundleMethodsWe undertook a retrospective review of all emergency admissions and inpatient AUGIB over a 1-month period to gather data on time of event, initial treatment given, Blatchford scores, time to endoscopy request, management of anticoagulation and mortality outcomes, as well as an anonymous staff survey of a range of junior doctors on the management of AUGIB. A prospective review of inpatient AUGIB over 1 month following implementation of the bundle and staff education was then conducted.ResultsThere were 91 inpatient OGD requests during August 22, of which 22 represented requests for AUGIB, the remaining were OP requests. Median age was 64 years (IQR 15), 68% were male. 59% presented with meleana (n=13). Following recognition of AUGIB, review by medical doctor was undertaken within <15 minutes to 29 hours. Blatchford score was calculated in 18% (n=4) cases, average score in our case load was 8.2. 50% received resuscitation with IVT, 27% received RBC but of these only 33% had hb <70. No patients received terlipressin, IV PPI was given in 27%, 90% had PT checked, 40% were high(>15). of those on aspirin it was stopped in 33% (n=1), 33% had clopidogrel stopped (n=1), all on DOACs were stopped (n=2). 55% had documented discussion with endoscopist, 73% had endoscopy requested <24 hours. Following endoscopy, an antithrombotic plan was made in 9%(n=2), all (n=13) who had peptic ulcers had PPI plan documented. Overall 30-day mortality was 9% (n=2), whilst 6-month mortality was 24%.Questionnaire data had 25 responses from junior doctors, 60% reported experience with AUGIB ≥ once a month. 86% felt confident recognising, and, 72% were confident managing AUGIB. 88% would stop all anticoagulation including aspirin. The reaudit is currently underway and will form discussion element of this projectConclusionsAUGIB in hospital setting are not managed to the standards we expect, with <20% having a Blatchford score calculated, and only 73% having OGD requested within 24 hours.Doctors are less comfortable in managing AUGIB than expected, especially with regard to anticoagulation decisions

• Publisher: BMJ Publishing Group LTD
• Subject: Aspirin / Cirrhosis / Clopidogrel / Endoscopy / Gastroenterology / Mortality / Peptic ulcers / Ulcers