PTH-155 Evidence for a ‘Weekend Effect’ in the Management of Acute GI Bleeding in a Central London Teaching Hospital

Abstract

Introduction NICE guidance recommends that endoscopy should be performed within 24 hours of admission with a non-severe upper gastrointestinal bleed (UGIB). This audit reviewed cases over a six month period in a central London teaching hospital to establish compliance. We also evaluated whether there was a greater delay at weekends compared to weekdays. Methods 41 patients were identified with a non-variceal UGIB. Patient notes were reviewed to collect data on arrival time, endoscopy time and findings, and clinical details to calculate a Rockall score. Arrival and endoscopy time were used to calculate time to endoscopy; these figures were used to compare weekend versus weekday performance. Results Rockall scores were normally distributed with mean of 3.8, median 4 and mode 4. The range was 0–10. Mean time from admission to endoscopy was 21 hours. 61% of patients had an endoscopy within the first 24 hours of admission, and therefore met NICE guidance. The mean Rockall score of patients receiving endoscopy within 24 hours was 4.32. Those whose endoscopy occurred later than 24 hours had a mean score of 3.3. Mean time to endoscopy in those admitted on weekdays was 17 hours, with 66.6% undergoing endoscopy within 24 hours. The range of waiting times was 1–48 hours. In comparison, mean time to endoscopy at weekends was 30 hours with 60% undergoing endoscopy within 24 hours. The range was 10–75 hours. 2 patients (5.1%) had a second UGIB during admission. Both of those were inpatients for other reasons at the time of their first bleed. Conclusion Only 61% of patients underwent endoscopy within 24 hours of admission. However those who got earlier endoscopies had higher mean Rockall scores which suggest they were prioritised appropriately. Patients admitted at the weekend waited longer on average for their endoscopy and even the quickest weekend endoscopy was 10 hours after arrival. There is undoubtedly some “weekend effect” seen. However, the percentage meeting the NICE guidance is similar (60% versus 66%). The longest weekend wait was 75 hours compared to 48 on weekdays,presumably as low-risk patients have a longer wait out of hours. The reason for the delay is likely multifactorial, but significantly the endoscopy department is closed over the weekend. To scope patients the on call endoscopist competes with emergency theatre lists. In a busy London hospital with a Major Trauma Centre and General, Orthopaedic and Vascular surgery, a sub-acute GI bleed will not be prioritised. The fundamental question for the hospital is whether the endoscopy department should open at the weekend. Costing has put this at almost £100 000 per annum (including a seven day out of hours on call nurse) to offer just an emergency service. Disclosure of Interest None Declared