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124 GASTROINTESTINAL BLEEDING AND TIMING OF ENDOSCOPY N Sarin, P Adams METHODS: Endoscopies are encoded by various billing and diagnostic codes based on findings, active bleeding, interventions, and timing of endoscopies. These codes were used to assess all in-patients from June 2005 to June 2006 for gastroenterologists covering call at London Health Sciences Centre (two acute care teaching hospitals) using the centralized data recording system. The off-hours endoscopies were compared with the regular-hours endoscopies, using Z test for independent proportions.
INTRODUCTION: Upper gastrointestinal bleeding is a common problem associated with significant morbidity and mortality. Classic studies show immediate endoscopies do not affect outcomes in patients; but endoscopic interventions have evolved since those original studies were published. However, a 24 hour endoscopy unit is costly to run, maintain and staff. The magnitude, frequency and outcomes of off-hours endoscopy is assessed in our institution.
RESULTS: From June 2005 to June 2006, 5 GI doctors caring for inpatients, there were 700 upper endoscopies performed; 110 off-hours (16%) and 590 during regular-hours (84 %). For both off-hours and regular-hours endoscopies, 11% revealed variceal bleeds. When comparing the off-hours endoscopies to regular-hours endoscopies, 57% were actively bleeding versus 24% (p < 0.001). When comparing endoscopic interventions, for the off-hours endoscopies 34% required intervention versus 14% for the regular-hours endoscopies (p < 0.001). The majority of cases (66% of off-hours and 86% of regular-hours endoscopies) did not require endoscopic intervention. For the off-hours endoscopies, 69 were during weekends and 41 were during weeknights.
CONCLUSIONS: A significant proportion (16%) of endoscopies are done urgently off-hours for upper gastrointestinal bleeding at London Health Sciences Centre Hospitals. These endoscopies are more likely to reveal active bleeding and receive endoscopic intervention compared with those done during regular hours, but frequently interventions are not required. It is not clear if those receiving urgent endoscopies have different outcomes from those receiving regular endoscopy. Using these identified cases, a detailed analysis is in progress to compare outcomes between those receiving immediate versus regular endoscopy.