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

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;...

Abstract

Background: Endoscopy within 24 hours 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 (>24h of admission).

Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between Nov-Dec 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 21.2h (IQR 12.0- 35.7), comprising median admission to referral and referral to endoscopy times of 8.1h (IQR 3.7- 18.1) and 6.7h (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 7am-7pm or via the Emergency Department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1d; p= 0.004), but not 30-day 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.

Citation

Siau, K., Hodson, J., Ingram, R., Baxter, A., Widlak, M. M., Sharratt, C., Baker, G. M., Troth, T., Hicken, B., Tahir, F., Magrabi, M., Yousaf, N., Grant, C., Poon, D., Khalil, H., Lee, H. L., White, J. R., Tan, H., Samani, S., Hooper, P., …Major, G. (2018). Time to endoscopy for acute upper gastrointestinal bleeding: results from a prospective multicentre trainee-led audit. United European Gastroenterology Journal, https://doi.org/10.1177/2050640618811491

• Journal Article Type: Article
• Acceptance Date: Oct 15, 2018
• Online Publication Date: Oct 28, 2018
• Publication Date: Oct 28, 2018
• Deposit Date: Jan 31, 2019
• Publicly Available Date: Feb 1, 2019
• Print ISSN: 2050-6406
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1177/2050640618811491
• Keywords: Upper gastrointestinal bleeding, haemorrhage, time to endoscopy, endoscopy, quality
• Public URL: https://nottingham-repository.worktribe.com/output/1510353
• Publisher URL: https://journals.sagepub.com/doi/abs/10.1177/2050640618811491
• Contract Date: Jan 31, 2019