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UK Comparative Audit of Upper Gastrointestinal Bleeding and the Use of Blood

British Society of Gastroenterology. UK Comparative Audit of Upper Gastrointestinal Bleeding and the Use of Blood. NHS Blood and Transplant British Society of Gastroenterology Royal College of Physicians. Outline. All UK hospitals invited to participate Anticipate 80-100% uptake

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UK Comparative Audit of Upper Gastrointestinal Bleeding and the Use of Blood

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  1. British Society of Gastroenterology UK Comparative Audit of Upper Gastrointestinal Bleeding and the Use of Blood NHS Blood and Transplant British Society of Gastroenterology Royal College of Physicians

  2. Outline • All UK hospitals invited to participate • Anticipate 80-100% uptake • Running from May-August 2007 • Identifying every new admission and inpatient upper GI bleed between 1st May and 31st June 2007 • Online data entry to be completed by 1st August 2007 • To report by December 2007

  3. Background • More than 60% of red blood cells are now transfused to medical patients. • Patients with Upper Gastrointestinal (UGI) bleeding are one of the leading medical patient groups using blood (~14% of all transfusions) • Last major audit of upper gastrointestinal bleeding in1990s by Tim Rockall et al • hospital mortality of 14% in patients admitted with gastrointestinal bleeding • 30% in those who bled whilst in-patients. • Rockall developed now widely used risk stratification system

  4. Background • The use of blood in the management and risk stratification of patients with upper gastrointestinal bleeding has not previously been systematically evaluated • Now time for a re-audit of acute upper gastrointestinal bleeding, specifically addressing this • NHSBT and BSG joint collaboration • Previous Royal College of Physicians comparative audits led to improvements in practice e.g. myocardial infarction and stroke • This audit of gastrointestinal bleeding and blood use can have similar positive effects upon performance

  5. The Practicalities • Clinical Lead for Endoscopy in each hospital to act as supervisor • Audit lead - main contact point for NHSBT project group and will be local audit co-ordinator. Responsible for all data entry (or ensure it happens) • Case identifier - will find details of all UGI bleeds and enter patients onto hospital linkage record

  6. Case Identification • Project group has identified best ways to find cases using pilot of case ascertainment • Each hospital will be expected to use 3 or 4 methods every day, and display posters • Will take around 1 hour per day (some more, some less) for case identifier • Suggest advertise audit in hospital so all clinical staff can contact case identifier directly with patients’ details

  7. Audit tool • Online data entry - unique hospital ID code • Only audit lead can enter (but can share code if wants help) • No patient ID will be entered • If case identified is not an upper GI bleed, will not be able to continue data entry • Every question accompanied by detailed help text • Can save and come back at any time • Always help available from project group

  8. Organisational audit tool • Completed by Clinical Lead for Endoscopy • Asks about facilities, frequency of GI bleeds, on call rotas, staff and equipment availability, radiology, liver units, etc. • Free text box…. • Will help us look at outcomes in context of available facilities and service provision

  9. Reports • A report from the RCP will be available by December 2007 • Will be presented nationally by project group and regionally and locally by individual hospitals • Report will be unique to each hospital • Compare your site vs national • Microsoft powerpoint slide show with your hospital’s results will be provided • Encourage audit lead to present locally

  10. Re-audit • Plan to see how things have changed over last 12 years since Rockall • First ever audit of blood use in GI bleeding • Will form basis of discussions re service provision and transfusion practice in gastroenterology • Encourage and implement local, regional and national changes to improve outcomes • Set audit standards to achievable targets / consider new guidelines • Re-audit to assess impact of changeson performance

  11. Steering group • Dr Kel Palmer (BSG, Edinburgh) • Professor Mike Murphy (NHSBT, Oxford) • Professor Richard Logan (Nottingham) • Dr Simon Travis (Oxford) • Mr Tim Rockall (Surrey) • Mr Derek Lowe (Royal College Physicians) • Project group (firstname.surname@nbs.nhs.uk) • Mr John Grant-Casey (NHSBT, Oxford) • Mr David Dalton (NHSBT, Birmingham) • Dr Sarah Hearnshaw (NHSBT, Oxford) • Details at www.bsg.org.uk

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