title: The utilization of standardized order sets using AASLD guidelines for patients with suspected cirrhosis and acute gastrointestinal bleeding.
abstract: To improve the adherence to AASLD (American Association for the Study of Liver Diseases) guidelines for variceal bleeding, we developed and implemented standardized order sets for gastrointestinal bleeding in our hospital on October 1, 2009. We performed medical record reviews of hospitalized patients with gastrointestinal bleeding with suspected cirrhosis from October 2009 to October 2010 to determine the use of octreotide, prophylactic antibiotics, and endoscopy. We reviewed 300 Medical records and identified 26 patients with suspected cirrhosis and gastrointestinal bleeding who had adequate information to determine whether or not the order set was used. Antibiotic was used in 76% of patients, octreotide was used in 76% of patients, and upper endoscopy was completed in 94% of patients within 24 hours. The use of antibiotics was higher than that used in historical controls in our hospital. Implementation of standardized order sets appears to have improved adherence to standard recommendations. However, larger studies with longer follow-ups are needed to evaluate this effect on clinical outcomes and cost of care.
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, USA.
authors.forename: Kunut
authors.initials: K
authors.lastname: Kijsirichareanchai
authors.forename: Saowanee
authors.initials: S
authors.lastname: Ngamruengphong
authors.forename: Ariwan
authors.initials: A
authors.lastname: Rakvit
authors.forename: Kenneth
authors.initials: K
authors.lastname: Nugent
authors.forename: Sreeram
authors.initials: S
authors.lastname: Parupudi
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D016145:Endoscopy, Digestive System / Q000706:statistics & numerical data; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000188:drug therapy; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D013004:Somatostatin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D013004:Somatostatin