Effectiveness of a protocol-based team approach to gastrointestinal hemorrhage

P. D. Stevens, J. Finegold, R. J. Garcia-Carrasquillo, P. H.R. Green, F. Meyer, R. Rosenberg, S. K. Lewis, M. Rubin, L. Schneider, J. Poneros, B. Diamond, C. J. Lightdale

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To evaluate a multidisciplinary gastrointestinal rapid response team (GIRRT) for the management of peptic ulcer bleeding (PUB). Methods: GIRRT patients: Consecutive patients evaluated by the GI service were managed by the GIRRT. Endoscopy (EGD) was performed within 12 hours of presentation. Ulcers were treated if active bleeding or a non-bleeding visible vessel was found. Active bleeding was treated with injection of 1:10,000 epinephrine followed by therapy with a 10 Fr heater probe or 10 Fr bipolar probe until bleeding stopped and the vessel was flattened. Adherent clots were not treated. Comparison patients: The comparison group (CG) was comprised of patients treated during the same time period for PUB by gastroenterologists not associated with the GIRRT. Treatment was by choice of the attending in the CG group. GIRRT and CG cases were matched for age, sex, lesion site, and stigmata. The outcome measures compared were: initial hemostasis rate, rebleeding rate (%RB), surgery rate (%SURG), transfusion requirement (#PC), mean length of stay (LOS) and mean total hospital charges (HC). Results: From July 1995 to November 1996, 307 patients were evaluated by the GIRRT for acute UGIB and 148 peptic ulcers (48%.) were diagnosed. Forty-five GIRRT and 45 CG ulcers were matched. The Charlson comorbidity index and the Baylor bleeding score were not significantly different between groups. Ulcer stigmata for the matched cohorts were: clean base (64%), visible vessel (17.7%), active bleeding (8.8%), clot (6.6%), and flat spot (2.2%). Initial hemostasis was 100% in both groups. GIRRT and CG patients are compared below. %RB #PC %SURG LOS HC GIRRT 15.5 3.37 4.4 9.37 $29819 CG 31.1 5.62 20.0 16.15 $76935 P value <0.05 <0.10 <0.05 <0.05 <0.05 Mortality in the GIRRT and CG groups was 4.4% and 11% respectively (<0.10). Conclusions: Management of patients by a protocol-based GI rapid response team significantly reduces rebleeding rate, surgery rate, total length of stay, and total hospital charges for patients with bleeding peptic ulcers.

Original languageEnglish (US)
Pages (from-to)AB102
JournalGastrointestinal endoscopy
Volume45
Issue number4
DOIs
StatePublished - 1997
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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