Auditing mortality from upper gastrointestinal haemorrhage: impact of a high dependency unit.
BACKGROUND
A retrospective audit conducted at our district general hospital indicated that mortality from upper gastrointestinal (GI) haemorrhage was above that reported from nearby centres.


OBJECTIVE
To assess the impact of establishing a high dependency unit (HDU) and agreed management protocol on subsequent mortality from upper GI haemorrhage at our hospital.


METHODS
Prospective audits were conducted before and after the establishment of an HDU. All acute admissions, as well as established inpatients with haematemesis and/or melaena, were examined for fitness for endoscopy, comorbidity, underlying diagnosis and the need for surgery.


METHODS
Over a two-year period, 524 patients were studied in the two audits. Risk scores were calculated and the 30-day mortality from all causes assessed.


RESULTS
There was a trend towards higher age and comorbidity during the second audit. Mortality was 9% and 10% during the first and second audits, respectively.


CONCLUSIONS
An increasing proportion of patients with bleeding are elderly and have associated comorbidity. Establishment of an HDU and agreed protocol did not reduce mortality at our centre.
Royal Gwent Hospital, Newport.
K C
KC
Kapur
J T
JT
Green
R G
RG
Turner
J
J
Swift
E D
ED
Srivastava
M C
MC
Allison
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D006396:Hematemesis / Q000175:diagnosis; D006757:Hospital Units; D006801:Humans; D008297:Male; D008485:Medical Audit; D008551:Melena / Q000175:diagnosis; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors