Influencing the practice and outcome in acute upper gastrointestinal haemorrhage

• DOI: 10.1136/gut.41.5.606
• Publication Date: 2010-06-30T16:46:12Z
• Authors: T A Rockall; R F A Logan; H B Devlin; T C Northfield
• Keywords: 0301 basic medicine; 03 medical and health sciences; 3. Good health

Aims — To assess changes in practice and outcome acute upper gastrointestinal haemorrhage following the feedback of data, reemphasis national guidelines, specific recommendations an initial survey. Design A prospective, multicentre, audit cycle. Forty five hospitals from three health regions participed two phases Patients Phase I: 2332 patients with haemorrhage; phase II: 1625 haemorrhage. Methods were evaluated respect to management (with reference guidelines), mortality, length hospital stay. Results Following distribution data first National Audit formulation for improving practice, proportion local guidelines or protocols rose 71% (32/45) 91% (41/45); 12 32 during revised their There was a small but significant increase all who underwent endoscopy (from 81% 86%), within 24 hours admission 50% 56%), use central venous pressure monitoring organ failure requiring blood transfusion those profound shock 30% 43%). was, however, no change high dependency beds joint medical/surgical risk cases. crude standardised mortality (13.4% 14.4% second phase). Conclusions Although many participating have made efforts improve by producing updating protocols, there has been only demonstrable some areas Audit. The detect any improvement may reflect this lack also fact that large deaths unselected study are not preventable; very could hope demonstrate out context clinical trial.