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       #Post#: 70--------------------------------------------------
       Gastrointestinal bleeding by early detection to identify the pat
       ients
       By: admini5 Date: May 11, 2015, 4:58 am
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       How to reduce inpatient admissions of patients with risk of
       gastrointestinal bleeding by early detection to identify the
       patients?
       Suspected upper GI bleeding is a common presentation in Accident
       and Emergency (A&E) or medical receiving units. Established
       practice is for patients to be admitted for assessment and
       investigation. However, a significant minority are at low risk
       of serious morbidity or mortality and usually do not require
       hospital-based intervention (transfusion, endoscopic therapy or
       surgery). These patients could be managed as outpatients, thus
       avoiding unnecessary hospital admission and potentially reducing
       demand on hospital beds with significant cost savings to the
       NHS.
       The Glasgow Blatchford score (GBS) identifies such low-risk
       patients. The score is based on simple clinical and laboratory
       data available soon after presentation.
       A GBS of zero identifies the approximately 16-22%% patients who
       are at extremely low risk (0.5%) of requiring interventions as
       described above.
       The possibility of emergency readmission with GI bleeding after
       initial presentation and discharge has been considered in a
       patient cohort. From the implementation of this scoring system
       at Glasgow Royal Infirmary all patients who were low scoring on
       Blatchford and therefore met the criteria for discharge were
       offered an endoscopy as an outpatient thus avoiding admission.
       In Stockton, all patients who scored zero and were under 50
       years old were offered an outpatient endoscopy. There were no
       consultations or adverse outcomes relating to the index GI bleed
       in either those who had their endoscopy as an outpatient or
       those who did not attend for their planned endoscopy (followed
       up through discussion with GP). From the published data (Stanley
       et al) there were therefore no adverse events relating to the
       introduction of this initiative. It should be noted that the
       patients who fulfilled the criteria for early discharge, that is
       GBS = 0, comprised a particularly low risk group at the time of
       presentation and therefore this lack of readmission is not
       clinically surprising.
       If the criteria for admission were to be extended to GBS = 1 or
       2 then this may affect readmission rates but is not the subject
       of this QIPP submission.
       In patients with significant GI haemorrhage and high-risk
       stigmata, the literature supports early endoscopy giving
       improved outcomes.
       For further information:
  HTML https://arms.evidence.nhs.uk/resources/qipp/29482/attachment
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