UK UGI bleeding audit 2007
Quality Standards for Organisation of Care
ESSENTIAL
Initial care / resuscitation

Facilities for resuscitation including level 2 care beds, and staff skilled in the management of
patients presenting with circulatory collapse [1]

Surgical team available on site, or arrangements for safe transfer of high risk patients to units
where therapeutic endoscopy available 24/7, if not available at site of presentation (based on
local factors, distance to nearest unit etc but all units must have a clear policy in place if
endoscopy not available on site) [2,3]

Availability of laboratory haematology / haemostasis testing (FBC, coagulation screen) 24/7
[4]

Local hospital guidelines for the management of patients with acute gastrointestinal
haemorrhage [1]
Endoscopy

Facilities for undertaking upper gastrointestinal endoscopy for all patients admitted with acute
UGI bleeding, and availability of urgent endoscopy in high risk patients [1] (See above for
patients who present with acute UGI bleed to unit where endoscopy not available)

Capability for applying endoscopic haemostatic therapies including banding or injection for
varices, and injection and/or thermal therapy, and/or endoscopic clips for non-variceal
bleeding. This includes an appropriately trained therapeutic endoscopist with nursing support,
and availability of equipment for achieving haemostasis [1,2]. Capability for placing
Sengstaken-Blakemore or Minnesota tube in patients with uncontrolled variceal haemorrhage.
Blood transfusion

Guidelines for the rapid provision of blood in emergencies [5]

Guidelines for the transfusion management of patients with massive haemorrhage [4]

Rapid availability of blood products 24/7, including:
-
Immediate availability of O RhD negative and O RhD positive blood [1,4]
-
Group compatible blood within 1 hour [6]
-
FFP and cryoprecipitate within 1 hour [6]
-
Platelets within 3 hours [6]

Availability of haematology/transfusion advice 24/7 [4]

Routine and reference serology available 24/7 to provide compatible blood for patients with
red cell antibodies [5]. Ideally this should be within 4 hours [6]
DESIRABLE

Audit of local outcomes of emergency admission for UGI bleeding with review of outcomes [7]

Participation in national / UK audit of UGI bleeding [7]

Surgical team available on site

Availability of TIPSS either in the unit or following reasonable transfer

Availability of endoscopy for patients with acute UGI bleeding on daily endoscopy list, for
those who do not require out of hours endoscopy [8]

Nurses trained in the use of therapeutic endoscopic techniques to be available for all
emergency endoscopy

A policy should be available for warfarin reversal [9]

Trainees to be under direct supervision for emergency endoscopy until passed as competent
at interventional techniques for endoscopic haemostasis [10]
References
1. BSG Endoscopy Committee. Non-variceal upper gastrointestinal haemorrhage:
guidelines. Gut 2002; 51: iv1-iv6
2. Care of patients with gastrointestinal disorders in the United Kingdom, a strategy for
the future, BSG 2006
3. Out of hours gastroenterology – A position paper. 2007
4. British Committee for Standards in Haematology. Guidelines on the management of
massive blood loss. Br J Haematol 2006; 135: 634-641
5. British Committee for standards in haematology. Guidelines for compatibility
procedures in blood transfusion laboratories. Transfusion Medicine; 2004 14: 59-73
6. Consensus opinion (Professor M Murphy, Dr S Allard, Dr A Copplestone, Dr J Wallis)
7. Good medical practice for physicians. RCP London 2004 :
8. BSG working party report. Provision of endoscopy related services in district general
hospitals. 2001
9. T. P. Baglin, D. M. Keeling, H. G. Watson, the British Committee for Standards in
Haematology (2006) Guidelines on oral anticoagulation (warfarin): third edition - 2005
update British Journal of Haematology 132 (3), 277–285.
10. JAG guidelines for the training appraisal and assessment of trainees in gastrointestinal
endoscopy. 2004