Title

Impact of a bleeding care pathway in the management of acute upper gastrointestinal bleeding.

Document Type

Article

Department

Gastroenterology

Abstract

Objectives: Upper gastrointestinal (UGI) bleeding carries high morbidity and mortality. The use of a bleeding care pathway (BCP) may improve outcomes, but the results are inconsistent in various studies.

Methods:

A BCP for Patients with UGI bleed with admission in a bleeding care unit (BCU) has been in use at our hospital since 2005. Prior to this, a high dependency unit was used for management of all emergencies including UGI bleeding. We compared the length of stay in the bleeding care/high dependency unit, total hospital stay, time to UGI endoscopy after admission, and survival between pre-2005 and post-2005 Patients.

Results:

Five hundred and fifty-one Patients were admitted with acute UGI bleed in the last 5 years, 121 belonged to pre-BCP (2004) period and 430 after implementation of the pathway (2005-2008). The mean (SD) time to UGI endoscopy improved from 21.3 (7.4) hours in the pre-BCU era to 9.4 (9.9) hours in BCU, p < 0.001. BCU stay was shorter from 2.41 (1.4) days pre-BCP to 1.93 (1.32) days post-BCP, (p < 0.001). The total hospital stay in pre-BCU (4.0 [2.08] days) as compared to BCU (4.13 [2.62] days, p = 0.58) was similar, there was no impact of BCU on survival.

Conclusion:

A BCU implementation showed improvement in time to UGI endoscopy, and did not reduce BCU stay or impact survival.

Publication

Indian Journal of Gastroenterology : official Journal of the Indian Society of Gastroenterology