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O44 new GI bleed nursing model & unit changes outcomes

O44 new GI bleed nursing model & unit changes outcomes
O44 new GI bleed nursing model & unit changes outcomes
Introduction: a dedicated GI bleed and liver unit (GIBLU) was created within the GI inpatient footprint. Each bay is staffed by 1 specially trained nurse to 4 patients with continuous monitoring available, a readily accessible medical team and 24-hour access to senior gastroenterology support. 
Aim: to assess the effectiveness of this change across the hospital.

Methods: the pre-implementation cohort contained all patients undergoing inpatient therapeutic endoscopy between April 2019 &amp Feb 2020. The post-implementation cohort contained all cases between April 2021 – Feb 2022. GI bleeds outside the GIBLU were also analysed. Measured covariates included age, sex, Charlson comorbidity index (CCI) and hospital frailty risk score (HFRS). Outcomes of interest included 30-day mortality (30DM), length of stay (LOS), readmission and rescoped rebleed rates. Chi2, Mann-Whitney U and Logistic Regression (LR) were calculated using p<0.05.

Results: there were 225 scoped bleeds in the 2019 cohort and 359 in the 2021 cohort. There were no significant differences in age (p=0.8450) or sex (p=0.2057) between the 2019 and 2021 cohorts. Overall 30DM in 2019 was 10.6%(95%CI:6.6–14.7) vs 11.1%(95%CI:7.8–14.4) in 2021, difference 0.5%(95%CI: -0.3–1.3), (p=0.8565). A comparison of the GIBLU and non-GIBLU cohorts in 2021 is given in table 1: [O44 Table 1 Key Outcomes (means) not included].
To help control for confounding 30DM LR prediction models were constructed: Coefficients = GIBLU: -0.67 (p=0.1378), Age: 0.02 (p=0.2801), Male Sex: 0.89 (p=0.0857), CCI: 0.21 (p=0.1004), HFRS: -0.07 (p=0.7571). Although none of the covariates reached significance GIBLU is the only protective factor with any strength.

Conclusions: despite increased demands on the service, length of stay and 30DM were both significantly lower in the GIBLU cohort which cannot be explained purely by demographic differences between the cohorts. Expanding the scope of GIBLU locally in 2022 seems highly likely given these results.
1468-3288
Mills, Matilda
353eb2cf-3683-45e0-8052-666fcbd335c4
Glover, Ben
fd695e85-2631-4815-ad41-32eb7931f993
Abosamra, Mahmoud
fe6debec-2115-405b-be97-2035fc64cfd3
Warren, Patrick
4e75c3c9-8c89-4db8-a81d-a9ffefb85ce9
Ahmadi, Sara
3cac8df8-5f52-4f45-9f66-c30596a5e2fd
Lambert, Gillian
9600b546-4447-4b5c-8fc0-0c57a83f2e67
Kinnaird, Nanette
79492da9-2128-4c8d-a358-f93de6b9695c
Wright, Mark
43325ef9-3459-4c75-b3bf-cf8d8dac2a21
Boger, Philip
bc7ca73e-a8ab-42be-b509-642f17981ba1
Stammers, Matt
a4ad3bd5-7323-4a6d-9c00-2c34f8ae5bd3
Mills, Matilda
353eb2cf-3683-45e0-8052-666fcbd335c4
Glover, Ben
fd695e85-2631-4815-ad41-32eb7931f993
Abosamra, Mahmoud
fe6debec-2115-405b-be97-2035fc64cfd3
Warren, Patrick
4e75c3c9-8c89-4db8-a81d-a9ffefb85ce9
Ahmadi, Sara
3cac8df8-5f52-4f45-9f66-c30596a5e2fd
Lambert, Gillian
9600b546-4447-4b5c-8fc0-0c57a83f2e67
Kinnaird, Nanette
79492da9-2128-4c8d-a358-f93de6b9695c
Wright, Mark
43325ef9-3459-4c75-b3bf-cf8d8dac2a21
Boger, Philip
bc7ca73e-a8ab-42be-b509-642f17981ba1
Stammers, Matt
a4ad3bd5-7323-4a6d-9c00-2c34f8ae5bd3

Mills, Matilda, Glover, Ben, Abosamra, Mahmoud, Warren, Patrick, Ahmadi, Sara, Lambert, Gillian, Kinnaird, Nanette, Wright, Mark, Boger, Philip and Stammers, Matt (2022) O44 new GI bleed nursing model & unit changes outcomes. Gut, 71, [A26]. (doi:10.1136/gutjnl-2022-BSG.44).

Record type: Meeting abstract

Abstract

Introduction: a dedicated GI bleed and liver unit (GIBLU) was created within the GI inpatient footprint. Each bay is staffed by 1 specially trained nurse to 4 patients with continuous monitoring available, a readily accessible medical team and 24-hour access to senior gastroenterology support. 
Aim: to assess the effectiveness of this change across the hospital.

Methods: the pre-implementation cohort contained all patients undergoing inpatient therapeutic endoscopy between April 2019 &amp Feb 2020. The post-implementation cohort contained all cases between April 2021 – Feb 2022. GI bleeds outside the GIBLU were also analysed. Measured covariates included age, sex, Charlson comorbidity index (CCI) and hospital frailty risk score (HFRS). Outcomes of interest included 30-day mortality (30DM), length of stay (LOS), readmission and rescoped rebleed rates. Chi2, Mann-Whitney U and Logistic Regression (LR) were calculated using p<0.05.

Results: there were 225 scoped bleeds in the 2019 cohort and 359 in the 2021 cohort. There were no significant differences in age (p=0.8450) or sex (p=0.2057) between the 2019 and 2021 cohorts. Overall 30DM in 2019 was 10.6%(95%CI:6.6–14.7) vs 11.1%(95%CI:7.8–14.4) in 2021, difference 0.5%(95%CI: -0.3–1.3), (p=0.8565). A comparison of the GIBLU and non-GIBLU cohorts in 2021 is given in table 1: [O44 Table 1 Key Outcomes (means) not included].
To help control for confounding 30DM LR prediction models were constructed: Coefficients = GIBLU: -0.67 (p=0.1378), Age: 0.02 (p=0.2801), Male Sex: 0.89 (p=0.0857), CCI: 0.21 (p=0.1004), HFRS: -0.07 (p=0.7571). Although none of the covariates reached significance GIBLU is the only protective factor with any strength.

Conclusions: despite increased demands on the service, length of stay and 30DM were both significantly lower in the GIBLU cohort which cannot be explained purely by demographic differences between the cohorts. Expanding the scope of GIBLU locally in 2022 seems highly likely given these results.

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e-pub ahead of print date: 19 June 2022

Identifiers

Local EPrints ID: 478001
URI: http://eprints.soton.ac.uk/id/eprint/478001
ISSN: 1468-3288
PURE UUID: c39b4e1d-828b-4691-8992-83d9508a7051
ORCID for Matt Stammers: ORCID iD orcid.org/0000-0003-3850-3116

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Date deposited: 19 Jun 2023 16:49
Last modified: 21 Sep 2024 02:15

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Contributors

Author: Matilda Mills
Author: Ben Glover
Author: Mahmoud Abosamra
Author: Patrick Warren
Author: Sara Ahmadi
Author: Gillian Lambert
Author: Nanette Kinnaird
Author: Mark Wright
Author: Philip Boger
Author: Matt Stammers ORCID iD

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