PTU-119 Upper gastrointestinal haemorrhage: is there a weekend effect? a review of two district general hospitals. (8th June 2018)

• Record Type: Journal Article
• Authors: Napier, Duncan; Anderson, Rebecca; Sheiybani, Giovanna; Roberts, Stephen; Williams, John; Brown, Jonathan
• Is Part Of: Gut. Volume 67(2018)Supplement 1
• Page Start: A250
• Page End: A250
• Publication Date: 2018-06-08
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2018-BSGAbstracts.497
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Upper gastrointestinal haemorrhage (UGIH) is a common emergency presentation with a mortality reaching 10%. 1 A 'weekend effect' has been described for UGIH with increased mortality rates for those admitted over a weekend. 2 These studies typically utilise information from national databases to describe this effect whereas this study sought to examine if there was a reproducible 'weekend effect' at two district general hospitals. Methods: Retrospective data was extracted from the endoscopy database for both hospitals in 2014, identifying all patients with an indication suggestive of UGIH. The Trust coding database was used to identify all patients with an ICD-10 code suggestive of UGIH. These datasets were amalgamated and electronic admission records subsequently analysed to exclude inpatient UGIH. Admission and discharge documentation, endoscopy reports, GP records and bereavements records were reviewed to confirm day and time of admission and endoscopy, and survival to 30 days. Chi-squared test was used to compare mortality between groups. Results: There were 552 admissions for acute UGIH in 2014, 518 patients underwent an emergency endoscopy, 23 either did not have an endoscopy or had an outpatient endoscopy, and 11 notes were unavailable or incomplete and thus excluded. There was no statistically significant difference in 30 day mortality for those admitted on a weekday (Mon 0000 – Fri 2359) vs a weekend (11.05% CI 7.98–14.79 vs 12.23% CI 7.92–17.79, p=0.68 X 2 ). Neither was there a statistically significant difference in 30 day mortality for those admitted out of hours (1700–0859) compared to in hours (12.60% CI 8.83–17.23 vs 10.39% CI 7.07–14.59 p=0.43 X 2 ). Although not statistically significant, there was an increase in 30 day mortality for those requiring an out of hours procedure (1800–0759) compared to day time (23.08% CI 14.89–33.09 vs 8.64% CI 6.16–11.72 p=0.19 X 2 ). Conclusions: This study found no correlation between the day or time of admission for UGIH and 30 day mortality, suggesting that despite reduced levels of staffing and endoscopic activity over the weekend or out of hours this had no impact on 30 day mortality. This may be explained by appropriate patient selection for urgent endoscopy.