Gastrointestinal (GI) bleeding is a medical emergency, needing urgent treatment. There are around 85,000 cases of GI bleeding in the UK each year, making it one of the most common medical emergencies. However, a number of studies have concluded that many UK hospitals have not been delivering the level of care these patients need. This led to the National Confidential Enquiry into Patient Outcome and Death 2015 (NCEPOD) being tasked with assessing the quality of the care hospitals provide.
NCEPOD has now reported its findings. It concludes that over half of hospitals lack essential services needed to deliver care to patients with acute GI bleeding.
The results focus on samples taken from over 31,000 patients who suffered a GI bleed in the first four months of 2013. Using these as a basis, NCEPOD now makes wide-ranging recommendations to improve patient safety.
The clinicians involved in the study identified that less than half of the patients received a standard of care that they would have accepted from their own practices. They concluded there was room for improvement in the clinical care of 45% of the patients reviewed. NCEPOD found patients were sometimes treated inappropriately while awaiting specialist input for definitive control of their bleeding. Significant numbers were given unnecessary medical treatment. Around a quarter of patients had blood products administered that could have been avoided.
Historically, hospitals have distinguished between upper and lower GI bleeding, divided by how far a scope passed through the mouth can reach to enable diagnosis of the cause of bleeding. NCEPOD concludes the distinction between upper and lower GI bleeding should end. Instead, NCEPOD recommends hospitals offering acute GI bleed services nominate a lead clinician to implement care pathways for all GI bleeds. These hospitals need to ensure services are available around the clock, including appropriate endoscopy, interventional radiology and surgical support.
NCEPOD proposes that hospitals which cannot deliver this level of care team with other local hospitals collectively to develop an appropriate network. Those hospitals that are not equipped to admit patients suffering a GI bleed still need to have in place a minimum level of care for in-patients being treated for other conditions, but who go on to develop GI bleeds during their admission. This means ensuring 24/7 access to endoscopy, interventional radiology and surgery.
Welcoming NCEPOD's recommendations, Andrew Clayton of Penningtons Manches' clinical negligence team explains: "We know from experience that treatment of patients with GI bleeds can be complex and that standards of care are variable across different hospitals. It is clear from NCEPOD's findings that the safety and care of patients with GI bleeds can be substantially improved. NCEPOD's recommendations are therefore very welcome.
"It will come as a surprise to many to learn that such a common medical emergency is not better co-ordinated. All hospitals providing acute care for GI bleeds should have in place clear pathways for managing patients. These should inform and determine the services hospitals offer, in line with NCEPOD's recommendations and therefore the resources needed to deliver safe patient care."