Introduction
Acute Upper GI bleeds (AUGIB) are common and are associated with significant mortality (1). Quick recognition, resuscitation and endoscopy improves patient outcomes (2). Care bundles are known to improve care. The BSG 2018 AUGIB bundle was designed to standardise care. We aimed to audit management of AUGIB in two sites in North East England.
Aims & Methods
We retrospectively analysed patients who underwent endoscopy for AUGIB from May-October 2023. We surveyed junior doctors to assess knowledge and confidence in managing AUGIB.
Results
98 patients were identified across 2 sites, the mean age was 66, and 58% were male. The AUGIB bundle was used in 10% cases.
Recognition: 83% presented to A+E with AUGIB with the remainder already inpatients. 78% presented with melaena, and 24% were suspected variceal bleeds.
Resuscitation: 100% had EWS scores, 87% received IV fluids, and 93% patients with Hb<70 received RBC transfusion.
Risk Assessment: Mean Glasgow-Blatchford score (GBS) was 9 for both sites. Site 1 had calculated a GBS in 65% cases, and site 2 in 88%.
Table 1: Summary of treatment
| | Site 1 | Site 2 | Overall |
| Variceal bleeds receiving antibiotics and terlipressin | 50% (n=5) | 69% (n=9) | 61% (n=14) |
| Aspirin continued | 60% (n=3) | 66% (n=6) | 64% (n=9) |
| Other antithrombotics held | 100% (n=17) | 91% (n=20) | 95% (n=37) |
Refer: of the 98 patients 70% discussed with endoscopist within 24hours, 47% had an OGD within 24 hours, and 30% required endoscopic intervention.
Review: 84% (site1) and 63% (site 2) had PPI plan, 50% (site 1) and 36% (site 2) had antithrombotic plan.
Of the small number of patients in which the bundle was used, all received appropriate resuscitation, all had GBS completed and all had OGD within 24hours of presentation.
200 surveys were sent across sites, 61 junior doctors responded. 73% felt confident in recognising AUGIB, and 65% felt confident in management. Only 32% knew appropriate initial variceal management. 40% were unsure when to call OOH endoscopist, and only 36% knew aspirin should continue.
Conclusion
Whilst recognition of AUGIB and fluid resuscitation is good, improvement is needed for risk assessment with GBS, management of suspected variceal bleeds, and timely referral for endoscopy. More detailed endoscopy reports are needed regarding PPI and antithrombotic plans.
More education with junior doctors is needed regarding management of AUGIB, and particularly when to call endoscopist and antithrombotic decisions. It would be helpful to educate staff to improve management. A reaudit of clinical management and the junior doctor survey is planned.
References
(1) Button LA, Roberts SE, Evans PA, Goldacre MJ, Akbari A, et al. (2011) Hospitalized incidence and case fatality for upper gastrointestinal bleeding from 1999 to 2007: a record linkage study. Aliment Pharmacol Ther 33: 64–76.
(2) McPherson SJ et al, National confidential enquiry into patient outcomes and deaths, Gatrointestinal haemorrhage, time to get control? 2015
Disclosure
Abstract submitted to BSG Live 24
