title: Out-of-hours endoscopy for non-variceal upper gastrointestinal bleeding.
abstract: BACKGROUND
  Most countries lack a well-coordinated approach to out-of-hours endoscopy. Economic constraints and lack of resources have been identified as important barriers.
  
  
  OBJECTIVE
  To assess the performance evaluation of an out-of-hours emergency endoscopy model of care.
  
  
  METHODS
  During a 3 year period (January 2010 to December 2012), data from consecutive outpatients (n = 332) with non-variceal acute upper gastrointestinal bleeding admitted or transferred to a single referral hospital were prospectively collected.
  
  
  RESULTS
  34% (n = 113) were direct admissions whereas 66% (n = 219) were transferred from other hospitals. Median time to upper endoscopy esophagogastroduodenoscopy (EGD) was 6 h and 7.7 h for direct admissions and transferred, respectively. EGD was performed within 24 h in 90% of the patients. Rebleeding, in-hospital mortality, 30 day mortality and need for surgery were respectively 9.8%, 5.8%, 7.4%, and 6.6% and were not significantly different between the two groups. Age, malignancy, and moderate to high clinical Rockall risk score were independent predictors of in-hospital mortality in both groups. Age remained as an important predictor of main outcomes in transferred patients, while comorbidities differed according to admission status and predictable outcomes.
  
  
  CONCLUSIONS
  This gastroenterology emergency model improved access and equity to out-of-hours endoscopy in an effective, safe, and timely way, recognized by the rates and the homogeneity observed in the outcomes, between transferred patients and direct admissions.
authors: Gastroenterology Department, Centro Hospitalar do Porto , Porto , Portugal.
authors: Isabel Maria Teixeira
authors: IM
authors: de Carvalho Pedroto
authors: Luís Araújo
authors: LA
authors: Azevedo Maia
authors: Paulo Sérgio
authors: PS
authors: Durão Salgueiro
authors: Elvira Manuela Costa Moreira
authors: EM
authors: Teles de Sampaio
authors: Ricardo Sigalho
authors: RS
authors: Küttner de Magalhães
authors: Maria João de Sousa
authors: MJ
authors: Barbosa Magalhães
authors: Ricardo Jorge
authors: RJ
authors: Marcos-Pinto
authors: Cláudia Camila Rodrigues
authors: CC
authors: Pereira Dias
authors: Mário
authors: M
authors: Dinis-Ribeiro
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration / Q000592:standards*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal / Q000592:standards*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: clinical-effectiveness; emergency care; non-variceal upper gastrointestinal bleeding; out-of-hours endoscopy; services provision