GUIDELINE REDUCES LENGTH OF STAY FOR UPPER GI BLEEDING

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GUIDELINE REDUCES LENGTH OF STAY FOR UPPER GI BLEEDING.

Most patients with upper gastrointestinal (GI) hemorrhage have uncomplicated courses, but the length of their hospital stay is often dictated by concerns about unexpected catastrophic rebleeding. This study evaluated whether a decision rule that separates patients into groups at low, intermediate, or high risk for adverse events could reduce length of stay without compromising care.

Four variables were used to determine risk: time since onset of bleeding, hemodynamic stability, comorbidity, and findings at endoscopy. Early hospital discharge was recommended for low-risk patients. The guideline was applied every other month for 14 months at a university-affiliated teaching hospital; during alternate, "control" months, the guideline was not used.

Overall, 299 patients were admitted with upper GI hemorrhage; 70 percent were classified as low risk, as defined by the guideline. Mean length of stay was significantly longer during control periods than intervention periods (4.6 vs. 2.9 days). There was no difference in rate of adverse outcome in the control and intervention groups one month after discharge.

Comment: This study confirms the safety and efficacy of a simple guideline for patients with upper GI bleeds, and supports the use of early endoscopy -- which allows confirmation of low-risk status and early discharge -- to improve efficiency of care.

— TH Lee

Published in Journal Watch General Medicine January 9, 1998

Citation(s):

Hay JA et al. Prospective evaluation of a clinical guideline recommending hospital length of stay in upper gastrointestinal tract hemorrhage. JAMA 1997 Dec 24 278 2151-2156.