Sa1078 Using a Process Improvement Program and Best Practice Data to Decrease Cost and Length of Stay Among Patients With Upper GI Bleeds in a Large Tertiary Hospital

Schembre, Drew; Connolly, Janice M.; Livingston, Brian; Bossinas, Chantee; Ely, R.; Ausk, Karlee; Brandabur, John J.; Crosby, Janis

doi:10.1016/s0016-5085(13)60687-3

Cited by 3 publications

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“…Use of the GBS (which was statistically inferior to the AIMS65 for predicting mortality) to determine acuity and patient disposition throughout the hospital resulted in a reduced length of stay by 14% and lowered cost by 18%. 24 Our study has several strengths. For one, we had clearly defined variables which ensured accurate scoring.…”

Section: Discussionmentioning

confidence: 96%

“…In addition, either score could warn physicians that a patient who has completed an upper endoscopy may require more intensive management such as in an intensive care unit or stepdown unit. Use of the GBS (which was statistically inferior to the AIMS65 for predicting mortality) to determine acuity and patient disposition throughout the hospital resulted in a reduced length of stay by 14% and lowered cost by 18% 24 …”

Section: Discussionmentioning

confidence: 99%

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Utility of the CANUKA Scoring System in the Risk Assessment of Upper GI Bleeding

Goff

Friedman

Toro

et al. 2022

Journal of Clinical Gastroenterology

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Background: The Canada-United Kingdom-Adelaide (CANUKA) score was developed to stratify patients who experience upper gastrointestinal bleeding (UGIB) to predict who could be discharged from the emergency department. Our aim was to determine if the CANUKA score could be utilized for UGIB in-patients undergoing endoscopy in predicting adverse outcomes. We additionally sought to establish a CANUKA score cut point to predict adverse outcomes and in-hospital mortality and compare this to established scoring systems.Methods: Between January 1, 2018 to June 30, 2019 all patients who underwent upper endoscopy after admission for UGIB were identified. We assigned a CANUKA score and compared the area under the receiver operating curve to established scoring systems.Results: Our data set included 641 patients, with a mean age of 59.5 ± 14.5 years. A CANUKA score ≥ 10 was associated with an adverse outcome [unadjusted odds ratio, 3.08 (1.79, 5.27)]. No patients experienced an adverse outcome with a CANUKA score <4. No patients died with a CANUKA score <6. Those with a CANUKA score of <10 had an in-hospital mortality of 2.1% compared with 6.8% for those with a score ≥ 10 (P = 0.008). AIMS65 had the best area under the receiver operating characteristic curve (0.809) for predicting mortality. Conclusions:The CANUKA score may serve utility as a predictor of adverse outcomes and mortality in patients admitted with UGIB undergoing endoscopy. Future studies, ideally prospective and multicenter, will be needed to validate its clinical utility.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Utility of the CANUKA Scoring System in the Risk Assessment of Upper GI Bleeding

Goff

Friedman

Toro

et al. 2022

Journal of Clinical Gastroenterology

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“…An earlier review at our institution of 166 UGIB patients revealed that using the GBS along with other elements aimed at improving physician communication decreased ICU admissions by 42%, LOS by 14% and hospital expense by 18%. 7 Chang and Shapiro estimated that if ICU care for UGI bleeding patients in higher utilisation hospitals were reduced to levels of lower utilisation hospitals, total costs would drop by about 6.5%. 2 Several elements limit this study.…”

Section: Discussionmentioning

confidence: 99%

“…Analysis at 6 months revealed an 18% reduction in hospital expenses for UGIB patients, about US$2000 per admission, with no identifiable adverse outcomes, due in large part to shorter lengths of stay and a decrease in admission to ICU. 7 The current study was undertaken to assess the utility of the GBS to direct bed placement for patients with UGIB.…”

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confidence: 99%

Semiautomated Glasgow-Blatchford Bleeding Score helps direct bed placement for patients with upper gastrointestinal bleeding

Schembre

Ely

Connolly

et al. 2020

BMJ Open Gastroenterol

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ObjectiveThe Glasgow-Blatchford Bleeding Score (GBS) was designed to identify patients with upper gastrointestinal bleeding (UGIB) who do not require hospitalisation. It may also help stratify patients unlikely to benefit from intensive care.DesignWe reviewed patients assigned a GBS in the emergency room (ER) via a semiautomated calculator. Patients with a score ≤7 (low risk) were directed to an unmonitored bed (UMB), while those with a score of ≥8 (high risk) were considered for MB placement. Conformity with guidelines and subsequent transfers to MB were reviewed, along with transfusion requirement, rebleeding, length of stay, need for intervention and death.ResultsOver 34 months, 1037 patients received a GBS in the ER. 745 had an UGIB. 235 (32%) of these patients had a GBS ≤7. 29 (12%) low-risk patients were admitted to MBs. Four low-risk patients admitted to UMB required transfer to MB within the first 48 hours. Low-risk patients admitted to UMBs were no more likely to die, rebleed, need transfusion or require more endoscopic, radiographic or surgical procedures than those admitted to MBs. No low-risk patient died from GIB. Patients with GBS ≥8 were more likely to rebleed, require transfusion and interventions to control bleeding but not to die.ConclusionA semiautomated GBS calculator can be incorporated into an ER workflow. Patients with a GBS ≤7 are unlikely to need MB care for UGIB. Further studies are warranted to determine an ideal scoring system for MB admission.

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Response to Integrating Gastrointestinal Bleeding Risk Scores Into Clinical Practice

Schembre

2020

Am J Gastroenterol

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Sa1078 Using a Process Improvement Program and Best Practice Data to Decrease Cost and Length of Stay Among Patients With Upper GI Bleeds in a Large Tertiary Hospital

Cited by 3 publications

References 0 publications

Utility of the CANUKA Scoring System in the Risk Assessment of Upper GI Bleeding

Utility of the CANUKA Scoring System in the Risk Assessment of Upper GI Bleeding

Semiautomated Glasgow-Blatchford Bleeding Score helps direct bed placement for patients with upper gastrointestinal bleeding

Response to Integrating Gastrointestinal Bleeding Risk Scores Into Clinical Practice

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