title: Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial.
abstract: BACKGROUND
  Many patients with upper gastrointestinal (GI) bleeding have a benign outcome and could receive less intensive and costly care if accurately identified. We sought to determine whether early endoscopy performed shortly after admission in the emergency department could significantly reduce the health care use and costs of caring for patients with nonvariceal upper GI bleeding without adversely affecting the clinical outcome.
  
  
  METHODS
  All eligible patients with upper GI bleeding and stable vital signs were randomized after admission to undergo endoscopy in 1 to 2 days (control) or early endoscopy in the emergency department. Patients with low-risk findings on early endoscopy were discharged directly from the emergency department. Clinical outcomes and costs were prospectively assessed for 30 days.
  
  
  RESULTS
  We randomized 110 consecutive stable patients with nonvariceal upper GI bleeding during the 12-month study period. The baseline demographic features, endoscopic findings, and the clinical outcomes were no different between the two groups. However the findings of the early endoscopy allowed us to immediately discharge 26 of 56 (46%) patients randomized to that group. No patient discharged from the emergency department suffered an adverse outcome. The hospital stay (median of 1 day [interquartile range of 0 to 3 days] vs. 2 days [interquartile range of 2 to 3 days], p = 0.0001) and the cost of care ($2068 [interquartile range of $928 to $3960] versus $3662 [interquartile range of $2473 to $7280], p = 0.00006) were significantly less for the early endoscopy group.
  
  
  CONCLUSIONS
  Early endoscopy performed shortly after admission in the emergency department safely triaged 46% of patients with nonvariceal upper GI bleeding to outpatient care, which significantly reduced hospital stay and costs.
authors.affiliation: Division of Gastroenterology, General Medicine, and Emergency Medicine, UC Davis Medical Center, Sacramento, California 95817, USA. jgllee@ucdavis.edu
authors.forename: J G
authors.initials: JG
authors.lastname: Lee
authors.forename: S
authors.initials: S
authors.lastname: Turnipseed
authors.forename: P S
authors.initials: PS
authors.lastname: Romano
authors.forename: H
authors.initials: H
authors.lastname: Vigil
authors.forename: R
authors.initials: R
authors.lastname: Azari
authors.forename: N
authors.initials: N
authors.lastname: Melnikoff
authors.forename: R
authors.initials: R
authors.lastname: Hsu
authors.forename: D
authors.initials: D
authors.lastname: Kirk
authors.forename: P
authors.initials: P
authors.lastname: Sokolove
authors.forename: J W
authors.initials: JW
authors.lastname: Leung
mesh_terms: D000328:Adult; D000368:Aged; D017046:Cost Savings; D004636:Emergency Service, Hospital / Q000191:economics; D016099:Endoscopy, Gastrointestinal / Q000191:economics*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000191:economics* / Q000209:etiology / Q000401:mortality; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000191:economics; D016019:Survival Analysis; D016896:Treatment Outcome; D014218:Triage / Q000191:economics*