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[Adherence to institutional clinical practice guideline on managing upper gastrointestinal bleeding, in a hospital in
Harold Benites-Goñi1, Ana Brañez-Condorena2, Fiorella Monge-Del Valle1
1Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú.
Insights
This study assessed adherence to upper gastrointestinal bleeding (UGB) clinical guidelines in Peru. Most guidelines showed good adherence, but restrictive transfusion recommendations require further investigation.
Area of Science:
- Gastroenterology
- Clinical Practice Guidelines
- Healthcare Quality Improvement
Background:
- The 2018 Clinical Practice Guideline (CPG) for upper gastrointestinal bleeding (UGB) management was established by Peru's Social Security (EsSalud).
- The CPG aims to standardize and optimize patient care for UGB based on evidence-based recommendations.
Purpose of the Study:
- To evaluate adherence to the EsSalud CPG for UGB at the Edgardo Rebagliati Martins National Hospital (HNERM).
- To identify specific areas of compliance and non-compliance with the CPG's recommendations.
Main Methods:
- A retrospective analysis of 184 adult patients with suspected UGB undergoing endoscopy between October 2019 and April 2020.
- Evaluation of adherence to 13 specific statements within the EsSalud CPG.
- Descriptive statistics and analysis of factors associated with non-adherence to statements with <80% compliance.
Main Results:
- Overall adherence to the 13 evaluated CPG statements ranged from 63.2% to 99.5%.
- Only two statements demonstrated adherence below the 80% threshold.
- The lowest adherence was observed for the restrictive transfusion recommendation, with non-compliance linked to higher Glasgow-Blatchford scores, elevated urea creatinine ratio, and lower admission hemoglobin.
Conclusions:
- The study found satisfactory adherence (≥80%) to 11 out of 13 evaluated CPG statements for UGB management.
- Further investigation is warranted to understand the reasons for suboptimal adherence to specific recommendations, such as restrictive transfusion.
- Strategies to improve adherence to all CPG statements should be explored to enhance patient outcomes.
Introduction:
In 2018, the Clinical Practice Guideline (CPG) for the Evaluation and Management of upper gastrointestinal bleeding (UGB) was published by the Social Security of Peru (EsSalud). It provides evidence-based statements to optimize the management of these patients.
Objective:
To evaluate the adherence to the statements of the CPG at the Edgardo Rebagliati Martins National Hospital (HNERM) of EsSalud (Lima, Peru).
Materials And Methods:
Retrospective study, which analyzed the database of all patients who came to the HNERM emergency service with suspected UGB and were scheduled for endoscopy between October 19, 2019 and April 15, 2020. We included those with ≥ 18 years of age. This database contains the main characteristics of the standardized medical history for patients with UGB. Compliance with 13 of the 34 statements of the EsSalud CPG was evaluated. The results were presented descriptively, and the factors associated with compliance with the statements with insufficient adherence (<80%) and with more than 100 evaluated participants were evaluated.
Results:
Data were obtained from 184 patients who met the inclusion criteria (men: 59.8%, median age: 70 years). The range of adherence to the 13 statements was from 63.2% to 99.5%. Only two statements had insufficient adherence (<80%). The statement with the least adherence was the recommendation to perform a restrictive transfusion. Noncompliance with this recommendation was found to be lower in those who had a higher score on the Glasgow-Blatchford index, a urea creatinine ratio > 60, and a lower hemoglobin on admission.
Conclusion:
Of the 13 statements evaluated, 11 had satisfactory adherence. It is important to explore the reasons why adherence is not adequate for some statements, and to evaluate methods to increase this adherence.
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