NEW GUIDANCE TO STOP PEOPLE DYING FROM ACUTE GASTRIC BLEEDING
New guidance launched today at The British Society of Gastroenterology's Annual Meeting aims to prevent unnecessary deaths with a toolkit that will improve the diagnosis and management of patients with acute gastric bleeding, particularly for those presenting at night and at the weekend.
A nationwide audit carried out by the British Society of Gastroenterology found one in ten patients affected die as a result of the bleed, rising to one in four when acute bleeding happens to patients who are already in hospital for some other reason. A range of treatments including endoscopy, X-ray procedures and surgery can stop bleeding and save lives, and the earlier these treatments are used, the better the outcome. Unfortunately in the UK whilst 60% of patients are admitted outside of normal working hours:
· Almost half of hospitals lack out of hours endoscopy, interventional X-ray treatments are even less available and about a quarter of patients are admitted to units with no relevant surgical team
· There is a lack of clarity concerning safe transfer of patients to referral centres or other hospitals where effective treatments are available
The toolkit was produced by the Academy of Medical Royal Colleges, the Association of Upper GI Surgeons, the British Society of Gastroenterology, Royal College of Nursing, Royal College of Physicians, Royal College of Radiologists, with funding support from the National Patient Safety Agency.
The toolkit defines nine service standards that are required to manage this patient group and will form the basis of both commissioning and redesigning care at local level. It will overcome the gross inequalities that currently exist in this area.
Dr Kel Palmer, CROMES Clinical Director, British Society of Gastroenterology said:
"Approximately 70,000 patients are admitted to hospital each year because of acute upper gastrointestinal bleeding and 1:10 of these will die as a direct result of their bleeding. The audit we carried out clearly highlighted that there is a great inequity in service provision across the UK. Which is exactly why we created the CROMES project - we need to define a range of service arrangements that currently pertain across the UK to manage patients presenting with upper gastrointestinal bleeding. We therefore hope that this toolkit can be used by hospitals to re-design services to provide 24/7 diagnosis and management for patients developing upper gastrointestinal bleeding.
We recognise that remote and rural hospitals with relatively limited numbers of relevant numbers of practitioners cannot provide 24/7 management but we have defined minimal standards which all patients should expect and defined criteria for safe transfer to hospitals where emergency therapy can be applied.
The CROMES document is not another guideline for best practice, nor is it necessarily another call for more resources within a limited health service. Rather it is a document that should be useful to hospitals and commissioners in their aspirations to re-design optimum services for patients presenting with this common and life threatening problem."
Dr Suzette Woodward, Director of Patient Safety, NPSA, said:
"Every patient with upper gastrointestinal bleeding should receive the right investigations, care and treatment when they need it, but reports made to the National Patient Safety Agency's National Reporting and Learning System showed this did not always happen.* The Scope for Improvement toolkit provides an inspiring, comprehensive, and very practical resource to support the provision of safe services for patients with upper gastrointestinal bleeding at all times, including at night or weekends. We urge all providers and commissioners of care to use the toolkit to make their services as accessible, effective and safe as possible.
Case Study: Phil Willan
Following his 2nd kidney transplant and problems with rejection episodes, he was given large doses of steroids. This caused major stomach irritation to an undiagnosed GI ulcer and a consequent acute upper gastrointestinal bleed (UGIB). At the time, Phil was unaware of the cause but was experiencing agonising stomach pains. He was given antacids which had no impact - in fact, the pain increased dramatically over the next few hours. Phil was already an inpatient at Manchester Royal Infirmary when he experienced the bleed although it occurred in the evening when the ward only had skeleton staff. When a surgeon finally spoke to him later the same evening and diagnosed his problem, he was rushed into theatre to undergo major stomach surgery.
Phil notes that even having undergone surgery 23 times, the GI bleed was easily the most excruciating pain he has ever experienced. However, he feels he was lucky as he was on a ward as an in-patient of a large teaching hospital where there was ready access to the health care professionals required to respond to his needs. He notes that presently there are still many parts of the country where other patients would not be so fortunate should they require the same sort of expert emergency care. He believes that he only survived because he had quick access to staff and treatments. If he had experienced the bleed whilst at home, the story may have been different.