Impact of protocol-based guidelines on the management and outcome of acute upper gastrointestinal hemorrhage in a district general hospital.

Abstract

A prospective audit of acute upper gastrointestinal (GI) hemorrhage was conducted between January and September 2000 at Frimley Park Hospital to determine the impact of introducing an upper GI bleeding protocol based on Rockall's initial risk scoring system. Fifty-seven patients and 52 patients were in the pre- and postprotocol phases of the study respectively. Fifty per cent (28) of the patients in the first phase and 40% (21) of the patients in the second phase belonged to the high risk group. In the preprotocol phase, endoscopy was performed in 86% (49) of cases with 60% of patients having an esophogastroduodenoscopy within 24 h. Thirty-three per cent of the high risk group failed to have an endoscopic examination within 24 h. Only two of 57 patients required surgery and the mortality was 14%. In the postprotocol phase, endoscopy was performed in 79% (42) of patients and 68% (36) patients had endoscopy within 24 h. Only four of 21 patients belonging to the high risk group had their endoscopy after 24 h of the admission. Patients were better monitored and mortality was reduced to 7.5%. Reduction of mortality from upper GI hemorrhage followed the introduction of an agreed protocol based on risk scoring.