Time to endoscopy for acute upper gastrointestinal bleeding:: Results from a prospective multicentre trainee-led audit

Keith Siau; James Hodson; Richard Ingram; Andrew Baxter; Monika M. Widlak; Caroline Sharratt; Graham M. Baker; Tom Troth; Ben Hicken; Faraz Tahir; Malik Magrabi; Nouman Yousaf; Claire Grant; Dennis Poon; Hesham Khalil; Hui Lin Lee; Jonathan R. White; Huey Tan; Syazeddy Samani; Patricia Hooper; Saeed Ahmed; Muhammad Amin; Sara Mahgoub; Khayal Asghar; Farique Leet; Matthew J. Harborne; Beata Polewiczowska; Sheeba Khan; Muhammad R Anjum; Michael McFarlane; Ella Mozdiak; Lauren D. O'Flynn; Ilona C. Blee; Rachel M. Molyneux; Ashok Kurian; Syed N. Abbas; Abdullah Abbasi; Aadil Karim; Asif Yasin; Fawad Khattak; Josephine White; Ruhina Ahmed; James A. Morgan; Lance Alleyne; Mohamed A. Alam; Naaventhan Palaniyappan; Victoria J Rodger; Paramvir Sawhney; Nasar Aslam; Theodore Okeke; Adam Lawson; Danny Cheung; Jeremy P. Reid; Ashish Awasthi; Mark R. Anderson; Joe R. Timothy; Sanjeev Pattni; Saqib Ahmad; Gillian Townson; Jeremy Shearman; Vanja Giljaca; Matthew J. Brookes; Ben R Disney; Neil Guha; Titus Thomas; Anthony Norman; Peter Wurm; Ashit Shah; Neil C. Fisher; Sauid Ishaq; Giles Major

doi:10.1177/2050640618811491

Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee-led audit

Keith Siau, James Hodson, Richard Ingram, Andrew Baxter, Monika M. Widlak, Caroline Sharratt, Graham M. Baker, Tom Troth, Ben Hicken, Faraz Tahir, Malik Magrabi, Nouman Yousaf, Claire Grant, Dennis Poon, Hesham Khalil, Hui Lin Lee, Jonathan R. White, Huey Tan, Syazeddy Samani, Patricia HooperSaeed Ahmed, Muhammad Amin, Sara Mahgoub, Khayal Asghar, Farique Leet, Matthew J. Harborne, Beata Polewiczowska, Sheeba Khan, Muhammad R Anjum, Michael McFarlane, Ella Mozdiak, Lauren D. O'Flynn, Ilona C. Blee, Rachel M. Molyneux, Ashok Kurian, Syed N. Abbas, Abdullah Abbasi, Aadil Karim, Asif Yasin, Fawad Khattak, Josephine White, Ruhina Ahmed, James A. Morgan, Lance Alleyne, Mohamed A. Alam, Naaventhan Palaniyappan, Victoria J Rodger, Paramvir Sawhney, Nasar Aslam, Theodore Okeke, Adam Lawson, Danny Cheung, Jeremy P. Reid, Ashish Awasthi, Mark R. Anderson, Joe R. Timothy, Sanjeev Pattni, Saqib Ahmad, Gillian Townson, Jeremy Shearman, Vanja Giljaca, Matthew J. Brookes, Ben R Disney, Neil Guha, Titus Thomas, Anthony Norman, Peter Wurm, Ashit Shah, Neil C. Fisher, Sauid Ishaq, Giles Major

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Abstract

Background: Endoscopy within 24?h of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24h of admission).
Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between November and December 2017. Analyses were performed to identify factors associated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups.
Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2h (IQR 12.0-35.7), comprising median admission to referral and referral to endoscopy times of 8.1?h (IQR 3.7-18.1) and 6.7?h (IQR 3.0-23.1), respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0% - 87.5%, p=0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7:00 and 19:00 hours or via the emergency department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1 d; p=0.004), but not 30-d mortality (p=0.344).
Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome.

Original language	English
Journal	United European Gastroenterology Journal
Early online date	28 Oct 2018
DOIs	https://doi.org/10.1177/2050640618811491
Publication status	E-pub ahead of print - 28 Oct 2018

Bibliographical note

doi: 10.1177/2050640618811491

Keywords

Upper gastrointestinal bleeding
Endoscopy
Quality Assurance
Health Care
time to endoscopy
haemorrhage
quality

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Siau, K., Hodson, J., Ingram, R., Baxter, A., Widlak, M. M., Sharratt, C., … Major, G. (2018). Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee-led audit. United European Gastroenterology Journal. https://doi.org/10.1177/2050640618811491 Copyright: Author(s) 2018
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Cite this

Siau, K., Hodson, J., Ingram, R., Baxter, A., Widlak, M. M., Sharratt, C., Baker, G. M., Troth, T., Hicken, B., Tahir, F., Magrabi, M., Yousaf, N., Grant, C., Poon, D., Khalil, H., Lee, H. L., White, J. R., Tan, H., Samani, S., ... Major, G. (2018). Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee-led audit. United European Gastroenterology Journal. Advance online publication. https://doi.org/10.1177/2050640618811491

@article{0ee322f1417a4f7dbded5ee277953bc3,

title = "Time to endoscopy for acute upper gastrointestinal bleeding:: Results from a prospective multicentre trainee-led audit",

abstract = "Background: Endoscopy within 24?h of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24h of admission).Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between November and December 2017. Analyses were performed to identify factors associated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups.Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2h (IQR 12.0-35.7), comprising median admission to referral and referral to endoscopy times of 8.1?h (IQR 3.7-18.1) and 6.7?h (IQR 3.0-23.1), respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0% - 87.5%, p=0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7:00 and 19:00 hours or via the emergency department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1 d; p=0.004), but not 30-d mortality (p=0.344).Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome.",

keywords = "Upper gastrointestinal bleeding, Endoscopy, Quality Assurance, Health Care, time to endoscopy, haemorrhage, quality",

author = "Keith Siau and James Hodson and Richard Ingram and Andrew Baxter and Widlak, {Monika M.} and Caroline Sharratt and Baker, {Graham M.} and Tom Troth and Ben Hicken and Faraz Tahir and Malik Magrabi and Nouman Yousaf and Claire Grant and Dennis Poon and Hesham Khalil and Lee, {Hui Lin} and White, {Jonathan R.} and Huey Tan and Syazeddy Samani and Patricia Hooper and Saeed Ahmed and Muhammad Amin and Sara Mahgoub and Khayal Asghar and Farique Leet and Harborne, {Matthew J.} and Beata Polewiczowska and Sheeba Khan and Anjum, {Muhammad R} and Michael McFarlane and Ella Mozdiak and O'Flynn, {Lauren D.} and Blee, {Ilona C.} and Molyneux, {Rachel M.} and Ashok Kurian and Abbas, {Syed N.} and Abdullah Abbasi and Aadil Karim and Asif Yasin and Fawad Khattak and Josephine White and Ruhina Ahmed and Morgan, {James A.} and Lance Alleyne and Alam, {Mohamed A.} and Naaventhan Palaniyappan and Rodger, {Victoria J} and Paramvir Sawhney and Nasar Aslam and Theodore Okeke and Adam Lawson and Danny Cheung and Reid, {Jeremy P.} and Ashish Awasthi and Anderson, {Mark R.} and Timothy, {Joe R.} and Sanjeev Pattni and Saqib Ahmad and Gillian Townson and Jeremy Shearman and Vanja Giljaca and Brookes, {Matthew J.} and Disney, {Ben R} and Neil Guha and Titus Thomas and Anthony Norman and Peter Wurm and Ashit Shah and Fisher, {Neil C.} and Sauid Ishaq and Giles Major",

note = "doi: 10.1177/2050640618811491",

year = "2018",

month = oct,

day = "28",

doi = "10.1177/2050640618811491",

language = "English",

journal = "United European Gastroenterology Journal",

issn = "2050-6406",

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Siau, K, Hodson, J, Ingram, R, Baxter, A, Widlak, MM, Sharratt, C, Baker, GM, Troth, T, Hicken, B, Tahir, F, Magrabi, M, Yousaf, N, Grant, C, Poon, D, Khalil, H, Lee, HL, White, JR, Tan, H, Samani, S, Hooper, P, Ahmed, S, Amin, M, Mahgoub, S, Asghar, K, Leet, F, Harborne, MJ, Polewiczowska, B, Khan, S, Anjum, MR, McFarlane, M, Mozdiak, E, O'Flynn, LD, Blee, IC, Molyneux, RM, Kurian, A, Abbas, SN, Abbasi, A, Karim, A, Yasin, A, Khattak, F, White, J, Ahmed, R, Morgan, JA, Alleyne, L, Alam, MA, Palaniyappan, N, Rodger, VJ, Sawhney, P, Aslam, N, Okeke, T, Lawson, A, Cheung, D, Reid, JP, Awasthi, A, Anderson, MR, Timothy, JR, Pattni, S, Ahmad, S, Townson, G, Shearman, J, Giljaca, V, Brookes, MJ, Disney, BR, Guha, N, Thomas, T, Norman, A, Wurm, P, Shah, A, Fisher, NC, Ishaq, S & Major, G 2018, 'Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee-led audit', United European Gastroenterology Journal. https://doi.org/10.1177/2050640618811491

TY - JOUR

T1 - Time to endoscopy for acute upper gastrointestinal bleeding:

T2 - Results from a prospective multicentre trainee-led audit

AU - Siau, Keith

AU - Hodson, James

AU - Ingram, Richard

AU - Baxter, Andrew

AU - Widlak, Monika M.

AU - Sharratt, Caroline

AU - Baker, Graham M.

AU - Troth, Tom

AU - Hicken, Ben

AU - Tahir, Faraz

AU - Magrabi, Malik

AU - Yousaf, Nouman

AU - Grant, Claire

AU - Poon, Dennis

AU - Khalil, Hesham

AU - Lee, Hui Lin

AU - White, Jonathan R.

AU - Tan, Huey

AU - Samani, Syazeddy

AU - Hooper, Patricia

AU - Ahmed, Saeed

AU - Amin, Muhammad

AU - Mahgoub, Sara

AU - Asghar, Khayal

AU - Leet, Farique

AU - Harborne, Matthew J.

AU - Polewiczowska, Beata

AU - Khan, Sheeba

AU - Anjum, Muhammad R

AU - McFarlane, Michael

AU - Mozdiak, Ella

AU - O'Flynn, Lauren D.

AU - Blee, Ilona C.

AU - Molyneux, Rachel M.

AU - Kurian, Ashok

AU - Abbas, Syed N.

AU - Abbasi, Abdullah

AU - Karim, Aadil

AU - Yasin, Asif

AU - Khattak, Fawad

AU - White, Josephine

AU - Ahmed, Ruhina

AU - Morgan, James A.

AU - Alleyne, Lance

AU - Alam, Mohamed A.

AU - Palaniyappan, Naaventhan

AU - Rodger, Victoria J

AU - Sawhney, Paramvir

AU - Aslam, Nasar

AU - Okeke, Theodore

AU - Lawson, Adam

AU - Cheung, Danny

AU - Reid, Jeremy P.

AU - Awasthi, Ashish

AU - Anderson, Mark R.

AU - Timothy, Joe R.

AU - Pattni, Sanjeev

AU - Ahmad, Saqib

AU - Townson, Gillian

AU - Shearman, Jeremy

AU - Giljaca, Vanja

AU - Brookes, Matthew J.

AU - Disney, Ben R

AU - Guha, Neil

AU - Thomas, Titus

AU - Norman, Anthony

AU - Wurm, Peter

AU - Shah, Ashit

AU - Fisher, Neil C.

AU - Ishaq, Sauid

AU - Major, Giles

N1 - doi: 10.1177/2050640618811491

PY - 2018/10/28

Y1 - 2018/10/28

N2 - Background: Endoscopy within 24?h of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24h of admission).Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between November and December 2017. Analyses were performed to identify factors associated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups.Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2h (IQR 12.0-35.7), comprising median admission to referral and referral to endoscopy times of 8.1?h (IQR 3.7-18.1) and 6.7?h (IQR 3.0-23.1), respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0% - 87.5%, p=0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7:00 and 19:00 hours or via the emergency department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1 d; p=0.004), but not 30-d mortality (p=0.344).Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome.

AB - Background: Endoscopy within 24?h of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24h of admission).Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between November and December 2017. Analyses were performed to identify factors associated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups.Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2h (IQR 12.0-35.7), comprising median admission to referral and referral to endoscopy times of 8.1?h (IQR 3.7-18.1) and 6.7?h (IQR 3.0-23.1), respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0% - 87.5%, p=0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7:00 and 19:00 hours or via the emergency department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1 d; p=0.004), but not 30-d mortality (p=0.344).Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome.

KW - Upper gastrointestinal bleeding

KW - Endoscopy

KW - Quality Assurance

KW - Health Care

KW - time to endoscopy

KW - haemorrhage

KW - quality

U2 - 10.1177/2050640618811491

DO - 10.1177/2050640618811491

M3 - Article

SN - 2050-6406

JO - United European Gastroenterology Journal

JF - United European Gastroenterology Journal

ER -