Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee‐led audit

Abstract

Background: Endoscopy within 24 h of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24 h of admission). Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between November and December 2017. Analyses were performed to identify factors associated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups. Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2 h (IQR 12.0-35.7), comprising median admission to referral and referral to endoscopy times of 8.1 h (IQR 3.7-18.1) and 6.7 h (IQR 3.0-23.1), respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0-87.5%, p ¼ 0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7:00 and 19:00 hours or via the emergency department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1 d; p ¼ 0.004), but not 30-d mortality (p ¼ 0.344). Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome.

Outcomes of Upper Gastrointestinal Bleeding Based on Time to Endoscopy: A Retrospective Study

“…Several studies have shown the prevalence of weekend effect in the United States and adverse outcomes related to it although no cause-effect relationship has been established [20]. Contrary to this hypothesis, an audit conducted in the UK showed that the time to endoscopy was independent of the weekend/weekday effect or whether the endoscopy was performed in the endoscopy suite versus the operating room [21]. International consensus on the management of patients with nonvariceal upper gastrointestinal bleeding recommends early endoscopy that is within 24 hours for most upper gastrointestinal bleeding.…”

British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding

“…The endoscopy referral or request should be made in a timely manner in order to achieve this outcome. 91 reVIeW We suggest that the endoscopy report should be reviewed by the ward team Level of evidence: Very low Level of recommendation: Strong Agreement: 90% Bundle recommendation: Review endoscopy report (100% agreement)…”

Timing of endoscopy for acute upper gastrointestinal bleeding in North West England: Results from a multicentre trainee‐led network

“…All adult patients admitted with suspected AUGIB who underwent gastroscopy were included. The standards assessed were as defined by Joint Advisory Group on GI Endoscopy (JAG) and reported in Siau et al 1 A total of 133 patients were included, of which 84% (n ¼ 112) were referred from Accident and Emergency while the remainder were from primary care. Median age was 65 years (range: 18-96), of which 65% (n ¼ 87) were male.…”