Outcome of accident and emergency room triaged patients with low risk non-variceal upper gastrointestinal haemorrhage.
An acute upper gastrointestinal haemorrhage (UGIH) is an expensive healthcare problem estimated to cost more than 2.5 billion dollars per annum in the United States. Recent British Society of Gastroenterology (BSG) guidelines (2002) advise that patients with low risk non variceal UGIH have a benign outcome and may be suitable for a relatively short hospital stay with attendant economic saving. We evaluated current clinical experience, endoscopy findings and length of hospital stay in our hospital. We carried out a two year retrospective data analysis of 395 Accident and Emergency Room triaged patients admitted with a low risk non variceal UGIH. Data variables included age, sex, presence of co morbid illness, endoscopic findings, Rockall Risk Score, mortality within the hospitalisation period and length and cost of hospital stay. Of the 395 haemodynamically stable patients identified, requiring 1,644 hospitalisation days, 320/395 (85.8%) had a Rockall Score < or =3. No endoscopic intervention was required in 366/395 (92.7%) of patients with a 2% overall mortality. The mean hospital length of stay (LOS) was 4.16, costing in excess of 1002,840 Euro. Following routine clinical practice for low risk non variceal UGIH, the subsequent duration of hospital stay was unnecessarily prolonged and costly. This highlights the need to initiate change, to monitor resource utilisation and implement early hospital discharge in appropriate patients.
Gleeson
F
F
Gastrointestinal Unit, Mater Misericordiae University Hospital, Dublin, Ireland. fcgleeson@eircom.net
Clarke
E
E
Lennon
J
J
MacMathuna
R
R
Crowe
J
J
D000059:Accidents; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006784:Hospitals, Teaching; D006801:Humans; D007494:Ireland; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D014218:Triage; D041742:Upper Gastrointestinal Tract / Q000473:pathology*