PMO-196 Reducing time to gastroscopy in upper gastrointestinal bleeding

IntroductionApproximately 300–350 patients present to Colchester General Hospital with an upper Gastrointestinal (GI) bleed per year. Guidelines advise endoscopy within 24 h of presentation. To improve our performance, we introduced a new system for prioritising these requests and monitored the results with repeated audits.MethodsAn audit of all upper GI bleed cases was conducted over the same 3-month period (March–May) in 2009, 2010 and 2011. For each case we obtained the times of admission, Oesophagogastroduodenoscopy (OGD) request, procedure and discharge. The discharge summary, and where necessary the notes, were consulted to separate cases admitted for bleeding from those where bleeding occurred after admission for another reason. The main theatre logs were consulted for numbers of emergency out-of-hours OGDs. In an effort to tackle to poor waiting times, the Early Morning Bleeder (EMB) system was introduced in July 2009. Two slots are allocated daily (excluding weekends) for gastroscopy for cases of upper GI bleeding at the beginning of the working day. Requests are collected in a box in the Medical Assessment Unit daily at 0730. The Rockall Score is used for prioritisation. These three audits thus compare the situation before and after introducing the EMB system.Results200920102011Total cases728085Bleeder admissions545953Wait from03.7%11.9%15.1%admission to129.6%35.6%49.1%OGD (days)≥268.5%52.5%35.8%Mean wait for OGD (days)3.261.95*1.66*Median length of stay (days)643**p