AUDITING MORTALITY FROM UPPER GASTROINTESTINAL HEMORRHAGE - IMPACT OFA HIGH DEPENDENCY UNIT

Background: a retrospective audit conducted at our district general ho spital indicated that mortality from upper gastrointestinal (CI) haemo rrhage was above that reported from nearby centres. Objectives: To ass ess the impact of establishing a high dependency unit (HDU) and agreed management protocol on subsequent mortality from upper GI haemorrhage at our hospital. Design: Prospective audits were conducted before and after the establishment of an HDU. All acute admissions, as well as e stablished inpatients with haematemesis and/or melaena, were examined for fitness for endoscopy, comorbidity, underlying diagnosis and the n eed for surgery. Subjects: Over a two-year period, 524 patients were s tudied in the two audits. Risk scores were calculated and the 30-day m ortality from all causes assessed. Results: There was a trend towards higher age and comorbidity during the second audit. Mortality was 9% a nd 10% during the first and second audits, respectively Conclusions: A n increasing proportion of patients with bleeding are elderly and have associated comorbidity. Establishment of an HDU and agreed protocol d id not reduce mortality at our centre.