pH Associates have been working with a number of professional bodies to co-ordinate the development of guidance to prevent people dying from gastric bleeding. The guidance was launched yesterday (Tuesday 15th March) and can be found on the Academy of Medical Royal Colleges website (click here). The news was also reported by the BBC yesterday (click here)
One in ten people who contract Upper gastro-intestinal bleeding (UGIB) die as a result, and the toll is even higher for those already in hospital when it happens – one in four. Patients need urgent treatment to stop the bleeding, using either endoscopy, a range of radiological procedures or surgery, but a 2007 audit showed that people were less likely to get the right treatment at night and at weekends, due to a variety of problems:
• no access to the endoscopy suite and equipment out of hours
• reliance on medical on-call rotas where not all participants were able to perform the appropriate procedures
• no access to nursing or technical staff with the skills to support endoscopists out of hours
• a lack of clarity on how to refer and transfer patients on to neighbouring hospitals if no local service was available out of hours
New guidance launched today aims to prevent unnecessary deaths with a toolkit to improve the diagnosis and management of UGIB, particularly by providing better care 24/7. The toolkit was produced by the Academy of Medical Royal Colleges, the Association of Upper GI Surgeons, the British Society of Gastroenterology, Royal College of Nursing, Royal College of Physicians, Royal College of Radiologists, with funding support from the National Patient Safety Agency.
The toolkit includes nine service standards to support both commissioning and providing NHS organisations to deliver effective, high quality UGIB services and enable patient access to the same quality of care wherever they live in the UK.
The nine service standards are:
1. There will be a nominated individual with the authority to ensure implementation by the contracted provider.
2. Contracted providers will ensure the minimum service is adequately resourced.
Assessment, risk scoring and resuscitation of your patients
3. All patients with suspected UGIB should be properly assessed and risk scored on presentation.
4. All patients should be resuscitated prior to therapeutic intervention.
Time to diagnostic or therapeutic intervention for your patients
5. All high risk patients with UGIB should be endoscoped within 24 hours, preferably on a planned list in the first instance.
6. For patients who require more urgent intervention either for endoscopy, interventional radiology or surgery formal 24/7 arrangements must be available.
Staffing of your service
7. The necessary team, meeting an agreed competency level, should be available throughout the complete patient pathway.
8. Each stage of the patient pathway should be carried out in an area with ‘appropriate’ facilities, equipment and support including staff experienced in the management of UGIB.
9. All hospitals must collect a minimum data set in order to measure service provision against auditable outcomes (case-mix adjusted as appropriate).