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Auditing mortality from upper gastrointestinal haemorrhage: impact of a high dependency unit
K C Kapur1, J T Green, R G Turner
1Royal Gwent Hospital, Newport.
Background:
A retrospective audit conducted at our district general hospital indicated that mortality from upper gastrointestinal (GI) haemorrhage was above that reported from nearby centres.
Objectives:
To assess the impact of establishing a high dependency unit (HDU) and agreed management protocol on subsequent mortality from upper GI haemorrhage at our hospital.
Design:
Prospective audits were conducted before and after the establishment of an HDU. All acute admissions, as well as established inpatients with haematemesis and/or melaena, were examined for fitness for endoscopy, comorbidity, underlying diagnosis and the need for surgery.
Subject:
Over a two-year period, 524 patients were studied in the two audits. Risk scores were calculated and the 30-day mortality from all causes assessed.
Results:
There was a trend towards higher age and comorbidity during the second audit. Mortality was 9% and 10% during the first and second audits, respectively.
Conclusions:
An increasing proportion of patients with bleeding are elderly and have associated comorbidity. Establishment of an HDU and agreed protocol did not reduce mortality at our centre.