Patients with chronic stomal inflammation, bleeding or persistent induration and/or mass formation should be followed up closely and investigated for recurrence or development of a new malignancy. There should be a low threshold to obtain an early definitive tissue diagnosis by taking biopsies to prevent local or systemic invasion.

The UK bowel cancer awareness campaigns appear to have improved public awareness of CRC and encouraged symptomatic individuals to seek urgent medical attention. The increase in 2WW referrals has not translated into better survival for symptomatic patients, partly due to the proportion presenting with advanced disease.

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77 patients (56%) were readmitted to hospital, 66 (86%) for clearly alcohol-related reasons. 13 more patients re-attended the AandE Department without readmission. 100 day readmission rate was 50%. 19 patients were readmitted twice and 23 patients >3 times. Readmission was independently associated with unemployment (p = 0.043), self-discharge after index admission (p = 0.011), relapse into drinking (p = 0.028), and (surprisingly) with having received a brief intervention regarding alcohol consumption during the index admission from a dedicated alcohol worker (n = 61, p = 0.009). Seven more patients had died by 21/05/13, 5 from liver disease. Conclusion Patients admitted to hospital with AUDs tend to be socially deprived, frequent hospital attenders with major physical and mental co-morbidity. They have high subsequent alcohol relapse and hospital readmission rates. Reduction of these is not achieved by interventions during the index admission and will require more pro-active measures post-discharge. Introduction National guidelines for the management of upper gastrointestinal (GI) bleeding exist and are based on conclusive evidence for effective clinical practice [1]. A mortality rate in acute admissions of 7% was reported in a national audit of upper GI bleeding [2]. This is an area of high volume, high risk and high cost where improvements can be made. Methods Three prospective audits of all acute admissions with upper GI bleed were undertaken for 4 week periods in 2009 (Audit 1), 2011 (Audit 2) and 2013 (Audit 3). After Audit 1, a new GI bleed proforma was introduced,a rolling,targeted educational programme for Accident and Emergency (AandE) and Medical Admissions Unit (AMAU) trainees was started,mandatory fields for risk scoring were included in the electronic requests and additional evening inpatient endoscopy lists were started. After Audit 2, Saturday and Sunday inpatient endoscopy lists were introduced and a dedicated endoscopy co-ordinator supervised triaging of patients to appropriate lists. Results A total of 115 patients were included in the three audits. 88% were admitted through AandE. There were no deaths and no patients underwent surgery in each of the three audit periods. 13% of all patients had lesions at endoscopy requiring therapy (6% band ligation for variceal bleeding, 7% endotherapy for peptic ulcer bleeding). The proportion of patients in whom a risk score was calculated in the 2009, 2011 and 2013 audits improved with each audit period with completion rates of 0%. 39% and 94%, respectively. (P < 0.001 for comparison of 2009 to 2011, and 2011 to 2013). However, the risk scores were inaccurately calculated by the admitting doctors in 46% and 33% of cases in Audit 1 and Audit 2. The improvement in accuracy between the audit periods was not statistically significant (p = 0.64). There was a statistically significant improvement in the time from admission to endoscopy between the audit periods 2009 and 2013 (median 33.5 h (range 15 to 214 h) versus 23.25 h (range 1.5 to 92 h) (p = 0.0017). The ...