Open AccessTime to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee‐led audit
Author(s) -
Siau Keith,
Hodson James,
Ingram Richard,
Baxter Andrew,
Widlak Monika M,
Sharratt Caroline,
Baker Graham M,
Troth Tom,
Hicken Ben,
Tahir Faraz,
Magrabi Malik,
Yousaf Nouman,
Grant Claire,
Poon Dennis,
Khalil Hesham,
Lee Hui Lin,
White Jonathan R,
Tan Huey,
Samani Syazeddy,
Hooper Patricia,
Ahmed Saeed,
Amin Muhammad,
Mahgoub Sara,
Asghar Khayal,
Leet Farique,
Harborne Matthew J,
Polewiczowska Beata,
Khan Sheeba,
Anjum Muhammad R,
McFarlane Michael,
Mozdiak Ella,
O'Flynn Lauren D,
Blee Ilona C,
Molyneux Rachel M,
Kurian Ashok,
Abbas Syed N,
Abbasi Abdullah,
Karim Aadil,
Yasin Asif,
Khattak Fawad,
White Josephine,
Ahmed Ruhina,
Morgan James A,
Alleyne Lance,
Alam Mohamed A,
Palaniyappan Naaventhan,
Rodger Victoria J,
Sawhney Paramvir,
Aslam Nasar,
Okeke Theodore,
Lawson Adam,
Cheung Danny,
Reid Jeremy P,
Awasthi Ashish,
Anderson Mark R,
Timothy Joe R,
Pattni Sanjeev,
Ahmad Saqib,
Townson Gillian,
Shearman Jeremy,
Giljaca Vanja,
Brookes Matthew J,
Disney Ben R,
Guha Neil,
Thomas Titus,
Norman Anthony,
Wurm Peter,
Shah Ashit,
Fisher Neil C,
Ishaq Sauid,
Major Giles
Publication year - 2019
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640618811491
Subject(s) - medicine , endoscopy , referral , prospective cohort study , emergency department , audit , surgery , emergency medicine , gastroenterology , family medicine , management , economics , psychiatry
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 = 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 = 0.004), but not 30‐d mortality (p = 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.