Impact of a Structured Approach to the Management of Acute Gastrointestinal Bleeding in Hospitalized Patients
The study will simply compare two time periods of treatment of patients with acute gastrointestinal bleeding. It is expected that when the bleedinga team is implemented, protocols optimizing the timing of endoscopy, and the care of patients with gastrointestinal bleeding will be implemented. All subjects who meet the inclusion criteria will be identified using ICD-9 Codes. The clinical course of patients with gastrointestinal bleeding from January 2005 to June 1st 2009 will be studied. Outcomes to be assessed will include length of stay, mortality, and rate of rebleeding. Various data about the hospitalization including the outcomes of hospitalization will be obtained by each participant?s chart review. Rebleeding will be defined using the following criteria: witnessed de novo hematemesis or hematochezia of any kind, de novo hemodynamic compromise (defined at SBP <90 or HR >110), transfusion of greater than 2 units of blood after the initial 24 hours of admission, or endoscopic evidence of bleeding from any lesion at the time of repeat endoscopy. Hospital DRG data will be collected from hospitalized computer records.
Patients with clinical evidence of acute GI bleeding and between the ages 18 to 80 years. GI bleeding will be identified by the following:
1. Witnessed or reported hematemesis, melenemesis or hematochezia (of greater than 100 ml) within the preceding 24 hours or
2. Witnessed or reported melenic stool within the preceding 24 hours without a reasonable source of bleeding elsewhere in the GI tract or
3. Return of greater than 100 ml of fresh blood or 500 ml of old blood (coffee grounds) by nasogastric lavage or
4. Clinical evidence of gastrointestinal bleeding and evidence of hemodynamic compromise (SBP < 90, or HR > 120)