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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 2/2017

Open Access 01-02-2017 | Clinical Investigation

Severe Gastrointestinal Haemorrhage: Summary of a National Quality of Care Study with Focus on Radiological Services

Authors: Simon J. McPherson, Martin T. Sinclair, Neil C. E. Smith

Published in: CardioVascular and Interventional Radiology | Issue 2/2017

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Abstract

Purpose of Study

To identify the remediable factors in the quality of care provided to patients with severe gastrointestinal (GI) bleeding.

Method

All hospital admissions in the first four months of 2013 with ICD10 coding for GI bleeding who received a transfusion of 4 units or more of blood. Up to five cases/hospital randomly selected for structured case note peer review. National availability of GI bleeding services data derived from organisational questionnaire completed by all hospitals.

Results

4563/29,796 (15.3%) of GI bleeds received 4 or more units of blood with a mortality rate of 20.2% compared to 7.3% without blood transfusion. 30.8% of GI bleeds received a blood transfusion. 32% (60/185) of hospitals admitting acute GI bleeds lacked 24/7 endoscopy. 26% (48/185) had on-site embolisation 24/7 with a further 34% (64/185) accessing embolisation by transfer within a validated formal network. Blood product use was inappropriate in 20% (84/426). Improved management, principally earlier senior gastroenterologist review and/or endoscopy, would have reduced blood product use in 25% (113/457). 14.5% (90/618) had a CT scan which identified the site of bleeding in 32% (29/90). 7.8% (36/459) underwent an Interventional Radiology (IR) procedure but a further 6.3% (21/33) should have had IR. 6% (36/586) underwent surgery with 21/36 for uncontrolled bleeding. In 20/35 IR was not considered despite the majority being suitable for IR. Overall 44% (210/476) received an acceptable standard of care according to peer review.

Conclusions

26 recommendations were made to improve the quality of care in GI bleeding, with six principle recommendations.
Appendix
Available only for authorised users
Footnotes
1
NCEPOD is an independent body. This project was undertaken as part of the Clinical Outcome Review Programme into Medical and Surgical Care which is funded by the Healthcare Quality Improvement Partnership on behalf of NHS England, NHS Wales, the Northern Ireland Department of Health, Social Services and Public Safety (DHSSPS), the States of Jersey, Guernsey, and the Isle of Man. Co-operation with national confidential enquiries is a statutory requirement for UK doctors and hospitals. Under NHS Act 2006 NCEPOD has been granted Section 251 approval by the Secretary of State for Health which permits the use of patient identifiable data without patient consent. All data are anonymised by NCEPOD non-clinical staff prior to review.
 
2
Local guidelines will need to define a major bleed pending National or International Guidelines/consensus.
 
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Metadata
Title
Severe Gastrointestinal Haemorrhage: Summary of a National Quality of Care Study with Focus on Radiological Services
Authors
Simon J. McPherson
Martin T. Sinclair
Neil C. E. Smith
Publication date
01-02-2017
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 2/2017
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-016-1490-3

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