A rectal bleeding algorithm can successfully reduce emergency admissions

Area of Science:

• Gastroenterology
• Internal Medicine
• Primary Care Medicine

Background:

• Acute lower gastrointestinal bleeding (LGIB) frequently leads to emergency hospital admissions.
• However, most LGIB cases do not necessitate blood transfusions or invasive interventions.
• There is a need for tools to safely manage LGIB patients in primary care settings.

Purpose of the Study:

• To develop and validate a risk assessment tool for identifying acute LGIB patients suitable for primary care management.
• To reduce unnecessary hospital admissions for LGIB.

Main Methods:

• A retrospective analysis using an existing nomogram identified key criteria for predicting transfusion needs.
• A simplified three-criterion algorithm (hemoglobin > 13 g/dL, systolic blood pressure > 115 mmHg, no anticoagulation) and care pathway were developed.
• The algorithm was prospectively applied to 57 patients over 16 weeks, supported by staff education and an emergency clinic.

Main Results:

• The algorithm and care pathway successfully avoided 35% (20/57) of potential admissions.
• Patients avoided admission received outpatient flexible sigmoidoscopy within 6 weeks.
• Among patients predicted to need admission, key indicators were low hemoglobin, low systolic blood pressure, and anticoagulation use.
• The rate of avoidable admissions decreased significantly from 50% to 1.8%.

Conclusions:

• A simple rectal bleeding algorithm can effectively and safely prevent unnecessary hospital admissions for LGIB.
• This tool supports the safe management of LGIB patients within primary care settings.