The importance of process issues as predictors of time to endoscopy in patients with acute upper-GI bleeding using the RUGBE data.
BACKGROUND
Early endoscopy has been shown to improve outcomes and optimize cost-effectiveness in nonvariceal upper-GI bleeding (NVUGIB). However, there is little information regarding clinical and process determinants that affect the time from onset of bleeding to performance of the endoscopy.


OBJECTIVE
The aim of this study was to identify factors that predict time to endoscopy in patients with new onset NVUGIB.


METHODS
Linear regression models were constructed with time between triage (outpatients) or onset of bleeding (inpatients) and the performance of endoscopy.


METHODS
The RUGBE is a nationwide, multicenter database collected for the purpose of obtaining descriptive data on patients with NVUGIB.


METHODS
The study population consisted of 1500 patients (89.6%) who underwent gastroscopy within 48 hours.


RESULTS
Median time to endoscopy was 12 hours (95% CI 11.0, 13.0). Endoscopy after working hours (regression coefficient [beta] -3.52; 95% CI -5.47, -1.58), availability of an endoscopy nurse on-call for the procedure (beta -2.48; 95% CI -3.83, -1.14), and admission to a hospital unit were associated with a shorter interval to endoscopy. In contrast, the presence of chest pain (beta 3.65; 95% CI 1.64, 5.67) or dyspnea (beta 2.79; 95% CI 1.10, 4.48), absence of gross blood on rectal examination (beta 2.20; 95% CI 0.69, 3.71), and inpatient status at onset of bleeding (beta 14.6; 95% CI 8.70, 20.4) were independent predictors of a delayed endoscopy. Subgroup analysis showed that actual time intervals as well as independent predictors of time until endoscopy differed between inpatients and outpatients.


CONCLUSIONS
Retrospective analysis.


CONCLUSIONS
The timing of endoscopy in patients with NVUGIB is dependent on both clinical and process parameters, which differ between inpatient and outpatient settings. They bear implications with regards to shaping practice and deciding on resource allocation in order to facilitate an early endoscopy, which is currently recommended for improved patient outcomes.
da Silveira
Eduardo B
EB
Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Québec, Canada.
Lam
Eric
E
Martel
Myriam
M
Bensoussan
Karen
K
Barkun
Alan N
AN
D000368:Aged; D015331:Cohort Studies; D019992:Databases as Topic; D004417:Dyspnea; D016099:Endoscopy, Gastrointestinal / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000451:nursing / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D041742:Upper Gastrointestinal Tract / Q000473:pathology* / Q000601:surgery