EARLY CLINICAL MANAGEMENT OF ACUTE UPPER GASTROINTESTINAL BLEEDING: A UK MULTISOCIETY CONSENSUS CARE BUNDLE
Keith Siau, Sarah Hearnshaw, Adrian Stanley, Lise Estcourt, Ashraf Rasheed, Andrew Walden, Mo Thoufeeq, Mhairi Donnelly, Russell Drummond, Andrew Veitch, Sauid Ishaq, A John Morris
Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency associated with considerable mortality. Despite the availability of AUGIB clinical guidelines, patient management frequently fails to achieve published standards. This document describes the development of an evidence-based care bundle detailing key interventions to be performed within the first 24 hours of care for patients presenting with AUGIB. This care bundle was commissioned by the British Society of Gastroenterology Endoscopy Quality Improvement Programme, with multi-society stakeholder representation from the Association of Upper Gastrointestinal Surgeons, Society of Acute Medicine, and NHS Blood and Transplant. Following evidence review, a modified DELPHI process reached consensus on 19 recommendations. These culminated in 13 corresponding care bundle items, enveloped within six management domains: Recognition, Resuscitation, Risk stratification, Rx (Treatment), Referral and Review (post-endoscopy care). The care bundle is intended for use in acute hospital departments by frontline staff to improve standards of care and patient outcomes in AUGIB.