EGS P09 Audit of Management of Acute Upper Gastrointestinal Bleeding against National Standard

Abstract

Abstract Background Acute upper gastrointestinal bleeding (AUGIB) remains a common gastrointestinal emergency with varying standards of care, management practices, patient outcomes and high mortality rates in the United Kingdom. National strategic initiatives have been implemented in response to this, the most recent and definitive one being the AUGIB care bundle released by the British Society of Gastroenterology (BSG) led multisociety consensus in 2019. We audited our performance against BSG AUGIB care bundle. Methods This was a retrospective cohort study conducted in a single surgical unit on all consecutive adult inpatients who received emergency oesophago-gastro-duodenoscopy (OGD) from September 2021 to September 2022. Patients who were scoped for indications other than AUGIB were excluded. Patient demographics, inpatient hospital notes, laboratory multisociety consensus results, NCEPOD data and endoscopy reports were studied and analysed. These findings were then compared against recommendations as described by the BSG multiconsensus care bundle. The compliance target for each step was 100%. This study was registered with Clinical Quality Project (LanQIP 14739). Results 150 OGDs were included; 79 (58.7%) were male and median age was 63 years (IQR 52.5-75.5). Median length of stay was 3.7 days (IQR 1.9-7.8). Melaena was the commonest presenting symptom (n=95, 63.3%). 54 (36%) presented with NEWS >2 and 12 (8.0%) in shock. Offending medications was the primary risk factor in 66 patients (44%). All OGDs had consultant supervision. 85 (56.7%) were performed in-hours. 55 (36.7%) had gastritis and 20 (13.3%) had oesophageal varices. 10 (6.7%) were re-admitted within 3 months. 30-day mortality was 8.0%. Our audit outcomes were as follow (Table 1): Conclusions Whilst senior clinician involvement was strong in our unit, there was a significant gap in concordance with BSG measures in applying the care bundle, GBS risk scoring and the resuscitation and medical management of acute bleeders. Formally implementing the AUGIB bundle from the emergency department into the admission unit will provide a framework for junior doctors to safely and systematically assess and resuscitate of patients with AUGIB, and guide timely planning for endoscopic intervention and follow-up by the senior clinical decision-maker. This should be continually re-audited to ensure improvement in performance together with outcome measures to ensure real change.