UPPER GASTROINTESTINAL-BLEEDING IN AN OPEN-ACCESS DEDICATED UNIT

The open-access high dependency bleeding unit in Aberdeen admits all p atients with suspected gastrointestinal bleeding from a stable adult p opulation of 468,000. The aim is to reduce mortality, morbidity and ho spital stay, and create a prospective whole community database. An agr eed management protocol is based on prompt resuscitation and early dia gnosis. From October 1991 to September 1993 there were 1,602 consecuti ve admissions with suspected upper or lower gastrointestinal haemorrha ge. Bleeding was confirmed in 1,098 of 1,324 patients with presumed up per gastrointestinal haemorrhage, (117 bleeding episodes per 100,000 p er year). The overall 30-day mortality was 3.9%, with all deaths attri butable to significant concurrent illness. Mortality from peptic ulcer bleeding was 5.3%, with an operation rate of 17% and surgical mortali ty of 8%. Rapid diagnosis allowed 48% of 523 patients with trivial ble eds to be discharged after a median stay of 24 hours. Centralised expe rtise and equipment is the essence of the unit's success. The interest s of patient care are better served, nursing skills are better develop ed and teaching opportunities better structured. The major improvement in clinical care, welcomed by hospital colleagues, management and gen eral practitioners, makes the unit an indispensable part of acute medi cal provision.