PTU-047 Creation of a dedicated proforma aimed at improving management of acute upper gi bleeding in a busy district general hospital. (17th June 2017) - Fox, J
Abstract : Introduction: Upper GI bleeding is a commonly-encountered medical emergency for which clear national guidelines exist. Prompt assessment, resuscitation and initiation of appropriate medical and endoscopic therapy is vital in improving patient outcomes. We aimed to improve management of both variceal and non-variceal upper GI bleeding in our district general hospital through the production of a dedicated proforma to assist clinician decision making and management of this common medical emergency. We hypothesised that management of this condition was frequently not performed in line with dedicated hospital and national guidelines due to poor awareness amongst medical staff of when to initiate specific therapies. Method: We created a questionaire designed to assess knowledge of key selected points from the hospital's guidelines for management of acute variceal and non-variceal GI bleeding. The questions spanned a range of key topics including resuscitation with blood products, the role of PPI therapy in acute upper GI bleeding, and timing of endoscopic therapy. A range of clinical staff, from consultants to Foundation year 1 doctors, were asked to complete the questionnaire which was marked out of 10. Correct answers were agreed upon, based on local and national guidelines. On the basis of results obtained, we identified the requirement for a proforma designed to assist in the management of patients with acute upper GI bleeding. Results: We obtained 30 responses to our questionnaire which covered different aspects of GI bleeding management. We broke down average scores by grade of doctor undertaking the survey as follows: FY1 4.25/10 SHO 4.5/10 SpR 7/10 Consultants 6/10 Questions which were most frequently answered incorrectly related to medical therapies for variceal bleeding, correct use of blood products, and timing of endoscopy based upon Blatchford score. Conclusion: Our study demonstrates that awareness of new recommendations for the management of acute upper GI haemorrhage is lacking amongst medical professionals of all grades. As such, patients may often not receive recommended therapies in a timely manner in order to maximise their chances of recovery and minimise complications. We feel that the production of a specific proforma will help to guide decision-making and bring management of this gastroenterological emergency uniformly in line with current guidelines. Reference: . NICE guidelines for acute upper gastrointestinal bleeding: https://www.nice.org.uk/guidance/cg141 Disclosure of Interest: None Declared