title: Impact of a bleeding care pathway in the management of acute upper gastrointestinal bleeding.
abstract: OBJECTIVE
  Upper gastrointestinal (UGI) bleeding carries high morbidity and mortality. The use of a bleeding care pathway (BCP) may improve outcomes, but the results are inconsistent in various studies.
  
  
  METHODS
  A BCP for patients with UGI bleed with admission in a bleeding care unit (BCU) has been in use at our hospital since 2005. Prior to this, a high dependency unit was used for management of all emergencies including UGI bleeding. We compared the length of stay in the bleeding care/high dependency unit, total hospital stay, time to UGI endoscopy after admission, and survival between pre-2005 and post-2005 patients.
  
  
  RESULTS
  Five hundred and fifty-one patients were admitted with acute UGI bleed in the last 5 years; 121 belonged to pre-BCP (2004) period and 430 after implementation of the pathway (2005-2008). The mean (SD) time to UGI endoscopy improved from 21.3 (7.4) hours in the pre-BCU era to 9.4 (9.9) hours in BCU, p < 0.001. BCU stay was shorter from 2.41 (1.4) days pre-BCP to 1.93 (1.32) days post-BCP, (p < 0.001). The total hospital stay in pre-BCU (4.0 [2.08] days) as compared to BCU (4.13 [2.62] days; p = 0.58) was similar; there was no impact of BCU on survival.
  
  
  CONCLUSIONS
  A BCU implementation showed improvement in time to UGI endoscopy, and did not reduce BCU stay or impact survival.
authors.affiliation: Department of Medicine, Section of Gastroenterology, Aga Khan University Hospital, Karachi, Pakistan. khalid.mumtaz@aku.edu
authors.forename: Khalid
authors.initials: K
authors.lastname: Mumtaz
authors.forename: Lubna
authors.initials: L
authors.lastname: Kamani
authors.forename: Saeed
authors.initials: S
authors.lastname: Hamid
authors.forename: Shahab
authors.initials: S
authors.lastname: Abid
authors.forename: Hasnain A
authors.initials: HA
authors.lastname: Shah
authors.forename: Wasim
authors.initials: W
authors.lastname: Jafri
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D019091:Critical Pathways / Q000458:organization & administration*; D004724:Endoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage; D009853:Omeprazole / Q000008:administration & dosage; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D000077585:Terlipressin; D013997:Time Factors; D016896:Treatment Outcome; D041742:Upper Gastrointestinal Tract
chemical_list: D008236:Lypressin; D000077585:Terlipressin; D009853:Omeprazole; D015282:Octreotide