HOME
Return to Table of Contents
90 ARE PATIENTS WITH ACUTE NONVARICEAL UPPER GI BLEEDING (ANVUGIB) PRESENTING OUTSIDE OF REGULAR HOURS RECEIVING QUALITY CARE LE Targownik, L Keyvani, SK Murthy, S Leeson BACKGROUND: ANVUGIB is among the most common reasons for presentation to a hospital’s emergency room. The standard of care for patients presenting with signs and symptoms of ANVUGIB is to receive prompt resuscitation and early endoscopy to confirm the diagnosis and to provide endoscopic therapeutics. While endoscopists are generally on site during regular working hours, they generally provide 'on call’ services on evenings and weekends, only coming into hospital if endoscopy is required. Therefore, it is possible ANVUGIB patients presenting to hospital overnight or on the weekend may not receive the same level of care as those presenting when endoscopists are 'in house’. This disparity could result in poorer outcomes and longer hospital stays for patients presenting at night or on weekends. Therefore, we sought to determine if there are significant differences in the process and outcomes of care between ANVUGIB patients presenting during regular hours and those arriving while endoscopists are 'on call’.
Section of Gastroenterology, University of Manitoba, Winnipeg, Manitoba
METHODS: We performed a retrospective review of all patients presenting to one of two tertiary care hospitals in Winnipeg, Manitoba from 1999-2004 with a admitting diagnosis of ANVUGIB who underwent diagnostic upper endoscopy. We separated the patients into one of two groups, based on whether they presented to the emergency room during regular working hours (Monday to Friday 8 am to 5 pm), or during 'call’ (all other times). The primary outcome measure was the development of any adverse outcome (in-hospital rebleeding, surgery, in-hospital mortality or readmission within 30 days for ANVUGIB). Other outcomes included the time to endoscopy, the need for endoscopic hemostasis and the length of hospital stay.
RESULTS: We analyzed 444 subjects of whom 176 presenting during regular hours, and 268 presented while the endoscopist was on call. There were no significant differences in baseline demographics, severity of presentation by pre-endscopic Rockall score or likelihood of receiving endoscopy within 8 h. 'On call’ patients were more likely undergo endoscopic hemostasis (38% vs 22%; P=0.02), though there were no differences in the incidence of adverse outcomes (19% vs 16%; P>0.2) or lengths of hospital stay. Patients presenting from 11 pm to 8 am did not fare worse than those presenting from 5 pm to 11 pm. Also, sicker patients (Preendoscopic Rockall Score
CONCLUSIONS: ANVUGIB patients presenting outside regular hours do not suffer any compromise in the quality of care. It is reasonable for endoscopists to provide 'on-call’ services outside regular hours instead of remaining 'in house’.
Unrestricted Grant from Altana Pharma