title: Post-endoscopy checklist reduces length of stay for non-variceal upper gastrointestinal bleeding.
abstract: OBJECTIVE
  To examine the effect of improved gastroenterologist-to-admitting service communication on hospital stay for upper gastrointestinal bleeding.
  
  
  OBJECTIVE
  a detailed checklist addressing factors relevant to discharge planning would shorten hospital stay, when added to the procedure report.
  
  
  METHODS
  Pre-post intervention design, recording balance measures (potential confounders).
  
  
  METHODS
  A Canadian university hospital.
  
  
  METHODS
  Intermittent 5- to 7-day batches of consecutive emergency patients presenting with non-variceal upper gastrointestinal bleeding as their primary problem. The durations of the background and intervention periods were 3 months (beginning 9 June 2003) and 4 weeks (beginning 8 September 2003), respectively.
  
  
  METHODS
  The gastrointestinal bleeding Quality Improvement and Health Information multidisciplinary team (quality improvement personnel; emergency physicians, hospitalists, gastroenterologists, in-patient and endoscopy nurses) developed a one-page checklist, outlining detailed recommendations (3-Ds-diet, drugs, discharge plan) to append to the procedure report.
  
  
  METHODS
  Difference in median length of hospital stay was the primary endpoint. As balance measures, demographics, bleeding severity, comorbidities, readmission rates, and various benchmark times were recorded prospectively.
  
  
  RESULTS
  Thirty-nine patients met the criteria in the background period (4 months, intermittently sampled), and 22 in the intervention period (4 weeks, continuously sampled). There were no significant baseline differences. Median in-patient stay was 7.0 (95% interquartile range 2-24) versus 3.5 (95% interquartile range 1-12) days for the background and intervention periods, respectively (P = 0.003). This remained significant when outliers (stay > 10 days) were removed (P = 0.02).
  
  
  CONCLUSIONS
  A checklist, with very specific recommendations to the admitting service, significantly reduced hospital stay for non-variceal gastrointestinal bleeding.
authors.affiliation: Department of Medicine (Divisions of Department of Medicine (Division of Gastroenterology and Hepatology), Medical University of South Carolina, Charleston, SC, USA. romagnuo@musc.edu
authors.forename: Joseph
authors.initials: J
authors.lastname: Romagnuolo
authors.forename: W W
authors.initials: WW
authors.lastname: Flemons
authors.forename: Linda
authors.initials: L
authors.lastname: Perkins
authors.forename: Linda
authors.initials: L
authors.lastname: Lutz
authors.forename: Peter C
authors.initials: PC
authors.lastname: Jamieson
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Hiscock
authors.forename: Lynda
authors.initials: L
authors.lastname: Foley
authors.forename: Jon B
authors.initials: JB
authors.lastname: Meddings
mesh_terms: D000289:Admitting Department, Hospital / Q000458:organization & administration* / Q000592:standards; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D015986:Confounding Factors, Epidemiologic; D019091:Critical Pathways; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D016099:Endoscopy, Gastrointestinal / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D005568:Forms and Records Control; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006396:Hematemesis / Q000175:diagnosis; D006785:Hospitals, University; D006801:Humans; D015274:Interdepartmental Relations; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008551:Melena / Q000175:diagnosis; D008875:Middle Aged; D010348:Patient Care Team / Q000592:standards; D010351:Patient Discharge / Q000592:standards*; D011785:Quality Assurance, Health Care; D014600:Utilization Review