946 A Complete Cycle Audit of the Appropriate Management of Stable Patients Presenting Acutely with a Lower GI Bleed Using the Oakland Score Risk Stratification Tool in Order to Avoid Unnecessary Admissions

Abstract

Abstract Aim The use of risk stratification tools such as the Oakland Score (OS) to identify patients with low risk of adverse outcomes (scale 0-35, safe discharge threshold ≤8) who present acutely with a Lower Gastrointestinal Bleed (LGIB) in order to avoid unnecessary admissions, in accordance with British Society of Gastroenterology (BSG) guidance. Method At a District General Hospital, data was collected retrospectively over six months. Patients who acutely presented with a LGIB were identified using patient handover lists and e-documentation was reviewed for a documented Oakland Score (OS). A departmental survey was conducted to ascertain knowledge of OS and LGIB assessment. Tailored teaching was subsequently delivered, including a summary sheet with a link to an e-calculator. A re-audit was conducted over three months to measure change of practice. Results Prior to intervention, 6/63 (10%) had a documented Oakland score (OS). Three patients had an OS <8 and were inappropriately admitted. A survey was completed by 11 members of the General Surgical team. Prior to intervention, 27% (3/11) were aware of OS and only 9% (1/11) reported using it practice. Following intervention, 16/38 (42%) had a documented OS. All patients (8/8) with an OS ≤8 were appropriately discharged. Conclusions The use of numerical risk stratification tools such as the Oakland Score, in compliance with BSG guidance, improved patient management and avoidance of inappropriate admissions. Targeted educative measures should be delivered to the department on a regular basis, to account for continual rotating of doctors and ensuring updated knowledge to further improve outcomes.