Effectiveness of a protocol-based team approach to gastrointestinal hemorrhage

P. D. Stevens, D. E. Milkes, S. Goodman, J. Finegold, C. J. Lightdale, R. J. Garcia-Carrasquillo, P. H R Green, Frances Meyer, R. Rosenberg, S. K. Lewis, M. Rubin, L. Schneider

Research output: Contribution to journalArticle

Abstract

AIM: To evaluate the clinical benefit of a protocol-based Gastrointestinal Rapid Response Team (GIRRT) for the management of acute peptic ulcer bleeding (PUB). Methods: Consecutive patients with upper GI bleeding managed by the GIRRT were followed prospectively. Their outcomes were compared to those of a comparison group (CG) consisting of patients treated during the same period for PUB by gastroenterologists not associated with the GIRRT. By GIRRT protocol, all patients had endoscopy (EGD) 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 thermal probe until bleeding stopped and the vessel was flattened. Non bleeding visible vessels were treated with thermal therapy alone. Adherent clots were not treated. Treatment for CG was determined by the individual gastroenterologist. Cases from GIRRT and CG were matched by age, lesion site, and stigmata. Measured outcomes were: mortality, initial hemostasis rate, rebleeding rate (%RB), surgery (%SURG), transfusions (PC), length of stay (LOS), and hospital charges (HO. Results: From July 1995 to August 1997, 63 patients treated by the GIRRT patients were matched to 63 CG patients. Ulcer stigmata for the matched cohorts were: clean base (64%), visible vessel (17%), active bleeding (11%), clot (6%), and flat spot (2%). Initial hemostasis was 100% in both groups. Mortality was 8% for CG and 3% for GIRRT (p=0.4). %RB PC (units) %SURG LOS(day) HC($) GIRRT 14.3 3.5 4.8 8.6 20.790. CG 30.2 5.2 17.5 16.4 44.380. P value 0.03 0.03 0.02 .001 .002 The Charlson comorbidity index and the Baylor bleeding score were not significantly different between groups. Conclusion: Management by a protocol-based GI rapid response team significantly reduces rebleeding rate, need for surgery, length of stay and hospital charges for patients with bleeding peptic ulcers.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume47
Issue number4
StatePublished - 1998
Externally publishedYes

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Gastrointestinal Hemorrhage
Hemorrhage
Peptic Ulcer
Hospital Charges
Christianity
Length of Stay
Hemostasis
Ulcer
Hot Temperature
Mortality
Epinephrine
Endoscopy
Comorbidity
Research Design
Therapeutics
Injections

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Stevens, P. D., Milkes, D. E., Goodman, S., Finegold, J., Lightdale, C. J., Garcia-Carrasquillo, R. J., ... Schneider, L. (1998). Effectiveness of a protocol-based team approach to gastrointestinal hemorrhage. Gastrointestinal Endoscopy, 47(4).

Effectiveness of a protocol-based team approach to gastrointestinal hemorrhage. / Stevens, P. D.; Milkes, D. E.; Goodman, S.; Finegold, J.; Lightdale, C. J.; Garcia-Carrasquillo, R. J.; Green, P. H R; Meyer, Frances; Rosenberg, R.; Lewis, S. K.; Rubin, M.; Schneider, L.

In: Gastrointestinal Endoscopy, Vol. 47, No. 4, 1998.

Research output: Contribution to journalArticle

Stevens, PD, Milkes, DE, Goodman, S, Finegold, J, Lightdale, CJ, Garcia-Carrasquillo, RJ, Green, PHR, Meyer, F, Rosenberg, R, Lewis, SK, Rubin, M & Schneider, L 1998, 'Effectiveness of a protocol-based team approach to gastrointestinal hemorrhage', Gastrointestinal Endoscopy, vol. 47, no. 4.
Stevens PD, Milkes DE, Goodman S, Finegold J, Lightdale CJ, Garcia-Carrasquillo RJ et al. Effectiveness of a protocol-based team approach to gastrointestinal hemorrhage. Gastrointestinal Endoscopy. 1998;47(4).
Stevens, P. D. ; Milkes, D. E. ; Goodman, S. ; Finegold, J. ; Lightdale, C. J. ; Garcia-Carrasquillo, R. J. ; Green, P. H R ; Meyer, Frances ; Rosenberg, R. ; Lewis, S. K. ; Rubin, M. ; Schneider, L. / Effectiveness of a protocol-based team approach to gastrointestinal hemorrhage. In: Gastrointestinal Endoscopy. 1998 ; Vol. 47, No. 4.
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abstract = "AIM: To evaluate the clinical benefit of a protocol-based Gastrointestinal Rapid Response Team (GIRRT) for the management of acute peptic ulcer bleeding (PUB). Methods: Consecutive patients with upper GI bleeding managed by the GIRRT were followed prospectively. Their outcomes were compared to those of a comparison group (CG) consisting of patients treated during the same period for PUB by gastroenterologists not associated with the GIRRT. By GIRRT protocol, all patients had endoscopy (EGD) 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 thermal probe until bleeding stopped and the vessel was flattened. Non bleeding visible vessels were treated with thermal therapy alone. Adherent clots were not treated. Treatment for CG was determined by the individual gastroenterologist. Cases from GIRRT and CG were matched by age, lesion site, and stigmata. Measured outcomes were: mortality, initial hemostasis rate, rebleeding rate ({\%}RB), surgery ({\%}SURG), transfusions (PC), length of stay (LOS), and hospital charges (HO. Results: From July 1995 to August 1997, 63 patients treated by the GIRRT patients were matched to 63 CG patients. Ulcer stigmata for the matched cohorts were: clean base (64{\%}), visible vessel (17{\%}), active bleeding (11{\%}), clot (6{\%}), and flat spot (2{\%}). Initial hemostasis was 100{\%} in both groups. Mortality was 8{\%} for CG and 3{\%} for GIRRT (p=0.4). {\%}RB PC (units) {\%}SURG LOS(day) HC($) GIRRT 14.3 3.5 4.8 8.6 20.790. CG 30.2 5.2 17.5 16.4 44.380. P value 0.03 0.03 0.02 .001 .002 The Charlson comorbidity index and the Baylor bleeding score were not significantly different between groups. Conclusion: Management by a protocol-based GI rapid response team significantly reduces rebleeding rate, need for surgery, length of stay and hospital charges for patients with bleeding peptic ulcers.",
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AU - Stevens, P. D.

AU - Milkes, D. E.

AU - Goodman, S.

AU - Finegold, J.

AU - Lightdale, C. J.

AU - Garcia-Carrasquillo, R. J.

AU - Green, P. H R

AU - Meyer, Frances

AU - Rosenberg, R.

AU - Lewis, S. K.

AU - Rubin, M.

AU - Schneider, L.

PY - 1998

Y1 - 1998

N2 - AIM: To evaluate the clinical benefit of a protocol-based Gastrointestinal Rapid Response Team (GIRRT) for the management of acute peptic ulcer bleeding (PUB). Methods: Consecutive patients with upper GI bleeding managed by the GIRRT were followed prospectively. Their outcomes were compared to those of a comparison group (CG) consisting of patients treated during the same period for PUB by gastroenterologists not associated with the GIRRT. By GIRRT protocol, all patients had endoscopy (EGD) 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 thermal probe until bleeding stopped and the vessel was flattened. Non bleeding visible vessels were treated with thermal therapy alone. Adherent clots were not treated. Treatment for CG was determined by the individual gastroenterologist. Cases from GIRRT and CG were matched by age, lesion site, and stigmata. Measured outcomes were: mortality, initial hemostasis rate, rebleeding rate (%RB), surgery (%SURG), transfusions (PC), length of stay (LOS), and hospital charges (HO. Results: From July 1995 to August 1997, 63 patients treated by the GIRRT patients were matched to 63 CG patients. Ulcer stigmata for the matched cohorts were: clean base (64%), visible vessel (17%), active bleeding (11%), clot (6%), and flat spot (2%). Initial hemostasis was 100% in both groups. Mortality was 8% for CG and 3% for GIRRT (p=0.4). %RB PC (units) %SURG LOS(day) HC($) GIRRT 14.3 3.5 4.8 8.6 20.790. CG 30.2 5.2 17.5 16.4 44.380. P value 0.03 0.03 0.02 .001 .002 The Charlson comorbidity index and the Baylor bleeding score were not significantly different between groups. Conclusion: Management by a protocol-based GI rapid response team significantly reduces rebleeding rate, need for surgery, length of stay and hospital charges for patients with bleeding peptic ulcers.

AB - AIM: To evaluate the clinical benefit of a protocol-based Gastrointestinal Rapid Response Team (GIRRT) for the management of acute peptic ulcer bleeding (PUB). Methods: Consecutive patients with upper GI bleeding managed by the GIRRT were followed prospectively. Their outcomes were compared to those of a comparison group (CG) consisting of patients treated during the same period for PUB by gastroenterologists not associated with the GIRRT. By GIRRT protocol, all patients had endoscopy (EGD) 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 thermal probe until bleeding stopped and the vessel was flattened. Non bleeding visible vessels were treated with thermal therapy alone. Adherent clots were not treated. Treatment for CG was determined by the individual gastroenterologist. Cases from GIRRT and CG were matched by age, lesion site, and stigmata. Measured outcomes were: mortality, initial hemostasis rate, rebleeding rate (%RB), surgery (%SURG), transfusions (PC), length of stay (LOS), and hospital charges (HO. Results: From July 1995 to August 1997, 63 patients treated by the GIRRT patients were matched to 63 CG patients. Ulcer stigmata for the matched cohorts were: clean base (64%), visible vessel (17%), active bleeding (11%), clot (6%), and flat spot (2%). Initial hemostasis was 100% in both groups. Mortality was 8% for CG and 3% for GIRRT (p=0.4). %RB PC (units) %SURG LOS(day) HC($) GIRRT 14.3 3.5 4.8 8.6 20.790. CG 30.2 5.2 17.5 16.4 44.380. P value 0.03 0.03 0.02 .001 .002 The Charlson comorbidity index and the Baylor bleeding score were not significantly different between groups. Conclusion: Management by a protocol-based GI rapid response team significantly reduces rebleeding rate, need for surgery, length of stay and hospital charges for patients with bleeding peptic ulcers.

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