Factors Associated With Inpatient Endoscopy Delay and its Impact on Hospital Length-of-Stay and 30-Day Readmission

Jacobs, Chelsea; Jaber, J.; Ladna, Michael; Ponniah, Sandeep A.; Madhok, Ishaan; Ruiz, N.; Podeschi, Haley; Gesiotto, Francesca M.; Khan, Walid; Moon, Nabeel; Mathews, April; Patel, Vikas; Styskel, Brett; Brar, Tony; Draganov, Peter V.; Yang, Dennis

doi:10.1016/j.cgh.2021.06.009

Cited by 10 publications

(11 citation statements)

References 10 publications

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“…The challenge is that most US hospitals do not have the resources to perform an EGD on all patients suspected to have an upper GI bleed because of the need for an in‐person gastroenterologist, specialized equipment, and anesthesia support. As a result, a significant proportion of patients are admitted to the hospital for observation that does not need an emergent EGD, and others receive delayed care 3 . Established means of performing risk stratification in the ED, such as the Glasgow Blatchford score (GBS) or nasogastric (NG) lavage, have significant limitations regarding sensitivity and specificity 4,5 …”

Section: Introductionmentioning

confidence: 99%

“…As a result, a significant proportion of patients are admitted to the hospital for observation that does not need an emergent EGD, and others receive delayed care. 3 Established means of performing risk stratification in the ED, such as the Glasgow Blatchford score (GBS) or nasogastric (NG) lavage, have significant limitations regarding sensitivity and specificity. 4,5 Video capsule endoscopy (VCE), first described by Iddan et al in 2000, is an alternative means to remotely view the lumen of the GI tract.…”

Section: Introductionmentioning

confidence: 99%

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Risk stratification with video capsule endoscopy leads to fewer hospital admissions in emergency department patients with low‐risk to moderate‐risk upper gastrointestinal bleed: A multicenter clinical trial

et al. 2021

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Objective: In US emergency departments (EDs), the physician has limited ability to evaluate for common and serious conditions of the gastrointestinal (GI) mucosa such as a bleeding peptic ulcer. Although many bleeding lesions are self-limited, the majority of these patients require emergency hospitalization for upper endoscopy (EGD).We conducted a clinical trial to determine if ED risk stratification with video capsule endoscopy (VCE) reduces hospitalization rates for low-risk to moderate-risk patients with suspected upper GI bleeding. Methods:We conducted a randomized controlled trial at 3 urban academic EDs. Inclusion criteria included signs of upper GI bleeding and a Glasgow Blatchford score <6.Patients were randomly assigned to 1 of the following 2 treatment arms: (1) an experimental arm that included VCE risk stratification and brief ED observation versus (2) a standard care arm that included admission for inpatient EGD. The primary outcome was hospital admission. Patients were followed for 7 and 30 days to assess for rebleeding events and revisits to the hospital. Results:The trial was terminated early as a result of low accrual. The trial was also terminated early because of a need to repurpose all staff to respond to the coronavirus disease 2019 pandemic. A total of 24 patients were enrolled in the study. In the experimental group, 2/11 (18.2%) patients were admitted to the hospital, and in the standard of care group, 10/13 (76.9%) patients were admitted to the hospital (P = 0.012). There was no difference in safety on day 7 and day 30 after the index ED visit.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk stratification with video capsule endoscopy leads to fewer hospital admissions in emergency department patients with low‐risk to moderate‐risk upper gastrointestinal bleed: A multicenter clinical trial

et al. 2021

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“…Regardless, these findings are contrary to recent studies suggesting that endoscopic delay is associated with increased LOS and add further merit toward the institution of an FBA and planned daytime procedures. 10 Although the rate of after-hours cases increased slightly after the introduction of the FBA, the FBA was associated with a statistically significant decrease in after-hours cases performed for intentional ingestions. In this way, the FBA was effective, as it showed that endoscopists were able to successfully defer intentional ingestions until daylight without an increase in AE.…”

Section: Discussionmentioning

confidence: 92%

Effect of Delayed Endoscopy Protocol on Timing and Safety of Endoscopy for Foreign Body Ingestion and Esophageal Food Impaction

Karb

DeLozier

Raad

et al. 2022

Journal of Clinical Gastroenterology

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Background and Aims: Endoscopic procedures for foreign body ingestion (FBI) and esophageal food impactions (EFI) performed during on-call hours are associated with increased stress, risk, and cost. We implemented a Foreign Body Algorithm (FBA) designed to delay all but the most urgent endoscopy for EFI and FBI until regular working hours.Methods: Using endoscopy records from multiple academic and community hospitals within a large integrated health system in the United states, we identified esophagogastroduodenoscopy (EGD) performed for food impactions and foreign body ingestions occurring between May 2011 and February 2021.Results: We identified 479 EGDs performed for FBI and EFI. The introduction of the FBA was associated with a shorter length of stay (LOS) for overall cases (0.35 vs. 0.8 d P < 0.001), day cases (0.16 vs. 1.0 d P < 0.001), and night cases (0.40 vs. 0.6 d P = 0.03). The introduction of the FBA did not change the rate of overall adverse events (AE) or night AE. AE from the entire cohort was rare (3%; 16 total). Of the AE, most were sedation related. The introduction of the FBA did not affect the overall rate of night cases or AE, but the rate of after-hours endoscopy for intentional ingestions decreased from 17.2% to 3.1% (P = 0.01).Conclusion: This is one of the largest studies of esophageal impactions and foreign bodies in adults in the United States, and the first to examine the effects of a protocol designed to avoid after-hours endoscopy. These results suggest that postponing after-hours EGD until the daytime is not associated with adverse safety outcomes or increased LOS.

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“…The cohort with no enteral access is created by delays in inpatient endoscopy service provision as seen in most units including ours. 17 In our institution, CVAD placements can be arranged in a timelier fashion than postpyloric tubes, as there are multiple avenues through which CVADs can be obtained (interventional radiology, infectious disease team, and intensive care). By contrast the ability to place an enteric tube under guidance requires a booking on endoscopic or radiological lists, services which are in high demand at our hospital.…”

Section: Discussionmentioning

confidence: 99%

“…By contrast the ability to place an enteric tube under guidance requires a booking on endoscopic or radiological lists, services which are in high demand at our hospital. Delays to accessing inpatient endoscopy are acknowledged as a limiting factor on the provision of timely care, 17 and while bedside approaches to the placement of postpyloric tubes have been reported as a feasible alternative to endoscopic or radiologically options 18,19 these are yet to be integrated widely into Australian practice, with cost and clinical governance posing the primary obstacles at the present time. Although steps to overcome these barriers are being undertaken, the use of PPN in this patient cohort could potentially negate the higher costs and increased clinical risks associated with CVAD placement while providing bridging nutrition for the several days usually required to access the currently available feeding tube placement options.…”

Section: Discussionmentioning

confidence: 99%

Are we underusing peripheral parenteral nutrition? A 5‐year retrospective review of inpatient parenteral nutrition practices

et al. 2022

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Background Peripheral parenteral nutrition (PPN) represents an alternative option to central parenteral nutrition (CPN) for patients requiring short‐term parenteral nutrition (PN). We hypothesized that the use of PPN could be increased in certain patient cohorts referred for PN in our facility. Methods A retrospective observational study investigating the clinical characteristics of patients receiving PN under the nutrition support team over a 5‐year period was undertaken. Patients who received PPN were reviewed descriptively. Of the patients who received CPN, representative samples were grouped into those who received PN for ≤7 or >7–28 days (n = 100 each, randomly assigned). Clinical characteristics considered included indication, duration and referring team for PN, and nutrition status. Descriptive statistics and binary logistic regression model for predictors of PN duration of ≤7 or >7–28 days were derived. Results Only four patients received PPN for a median of 4 days, most of whom required this route because of loss of central venous access for CPN. A high proportion of patients with no enteral access received CPN for ≤7 days, whereas the majority of patients with malabsorption required >7–28 days of CPN. Being referred for PN following upper gastrointestinal surgery increased the likelihood of CPN use for >7 days (relative risk, 5.7; 95% CI, 1.7–18.9; P = 0.004). Conclusion Within our service, PN referrals for no enteral access may represent a group in whom PPN could be used in the first instance; those referred with an indication of malabsorption or following upper gastrointestinal surgery may benefit from early commencement of CPN.

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Factors Associated With Inpatient Endoscopy Delay and its Impact on Hospital Length-of-Stay and 30-Day Readmission

Cited by 10 publications

References 10 publications

Risk stratification with video capsule endoscopy leads to fewer hospital admissions in emergency department patients with low‐risk to moderate‐risk upper gastrointestinal bleed: A multicenter clinical trial

Risk stratification with video capsule endoscopy leads to fewer hospital admissions in emergency department patients with low‐risk to moderate‐risk upper gastrointestinal bleed: A multicenter clinical trial

Effect of Delayed Endoscopy Protocol on Timing and Safety of Endoscopy for Foreign Body Ingestion and Esophageal Food Impaction

Are we underusing peripheral parenteral nutrition? A 5‐year retrospective review of inpatient parenteral nutrition practices

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