NICE Evidence Update: Acute Upper Gastrointestinal Bleeding
A summary of selected new evidence relevant to NICE clinical guideline 141 'Acute upper gastrointestinal bleeding: management' (2012)
This Evidence Update provides a summary of selected new evidence published since the literature search was last conducted for the following NICE guidance: Acute upper gastrointestinal bleeding. NICE clinical guideline 141 (2012) A search was conducted for new evidence from 23 September 2011 to 20 February 2014. A total of 6061 pieces of evidence were initially identified. After removal of duplicates, a series of automated and manual sifts were conducted to produce a list of the most relevant references.
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ERCP – The Way Forward, A Standards Framework
Mark Wilkinson, (BSG Endoscopy, working party convenor and chairman) et al.
To improve the quality and availability of ERCP in the UK, a working party was set up incorporating a number of stakeholders (Appendix 3) to make recommendations to achieve this goal. The attached framework document is the output of that process. It is recognised that not all changes can be achieved immediately, but that these are the standards to be aimed for. Though regulatory frameworks differ among the 4 nations of the UK (and delegates from Scotland, Wales and Ireland were represented on the working party) it is intended that this framework will be applicable to the whole of the UK.
In brief its recommendations are:
- ERCP should only be carried out in facilities dedicated to high standards of performance and safety, as measured by key performance indicators.
- That there should be a minimum of 75 cases per annum for ERCP endoscopists, and 150 cases minimum per facility, although we should be aiming for a minimum of 100 cases and 200 cases respectively.
- That ERCP services should work collaboratively in a regional or hub-and-spoke model, with simple and rapid referral pathways established.
- That facilities for urgent or emergency ERCP should be widely available.
- That minimum standards for independent practitioners should be based on intention to treat and include a >=85% cannulation rate of virgin papillae, CBD stone clearance for >=75% of those undergoing 1st ever ERCP, and for patients with an extra-hepatic stricture, successful stenting with cytology or histology where appropriate at 1st ERCP in >=80%.
- That performance criteria should be monitored by a detailed audit and feedback process via a strengthened JAG/GRS process, and be incorporated into consultant appraisal.
- That the organisation and standards for training for ERCP should follow from the above performance criteria.
- That newly appointed consultants are mentored to ensure a safe and effective transition from trainee to independent practitioner.
- That high quality performance in ERCP service and training should support high quality research.
- There should be a national registry of ERCP cases to monitor practice and outcomes which will aid a cycle of continuous improvement and provide research data to plan better care in the future.
Wednesday, 16 April 2014 15:02
In recent years a key area of concern for the BSG has been the lack of 24/7 provision of Acute Upper GI Bleeding (AUGIB) services. With a mortality rate of 10% and no notable improvement on this rate for years, the lack of out-of-hours coverage of services for AUGIB services is a challenge which must be urgently addressed.
Over the past year, the BSG has worked closely with NHSIQ to help identify areas which do not have AUGIB services available at all times, as well as how we can support gastroenterologists across the country to improve the availability of these services. Together we have produced a report which provides an overview of this project. Click here to read the report.
The survey, which is at the heart of this report, found that 23% of endoscopy units in England do not have AUGIB services that offer endoscopy patients 24/7 if required, and that 44% of units do not offer all acute admissions an endoscopy within 24 hours of admission with a GI bleed. You will note that the BSG, with support from NHS IQ, held workshops on this issue earlier this year.
The BSG will continue to campaign on this important issue and work with members and other bodies to promote improved provision of 24/7 AUGIB services.
Alcohol Treatment Matrix
Thursday, 03 April 2014 09:11
An innovative way of presenting evidence on alcohol treatment has been praised by several BSG members - the 'Go to Matrix' which presents a lot of clinical information in a clear way:
The Alcohol Treatment Matrix is concerned with the treatment of alcohol-related problems among adults (another deals with drug-related problems). It maps the treatment universe and for each sub-territory (a cell) lists the most important UK-relevant research and guidance. Across the top, columns move from specific interventions through how their impacts are affected by the widening contexts of practitioners, management, the organisation, and whole local area treatment systems. Down the rows are the major intervention types implemented at these levels. Inside each cell is our pick of the most important documents relevant to the impact of that intervention type at that contextual level. Visit the matrices page for articles, presentations, and a video explaining their genesis and construction.
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