Impact of a bleeding care pathway in the management of acute upper gastrointestinal bleeding.
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Date
2011-03
Journal Title
Journal ISSN
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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.
Description
Keywords
Gastrointestinal bleeding, Outcome research, Quality of care
Citation
Mumtaz Khalid, Kamani Lubna, Hamid Saeed, Abid Shahab, Shah Hasnain A, Jafri Wasim. Impact of a bleeding care pathway in the management of acute upper gastrointestinal bleeding. Indian Journal of Gastroenterology. 2011 Mar-Apr; 30(2): 72-77.