Vnitr Lek 2005, 51(1):36-40

Our experience with the new organisation of care of patients with acute upper gastrointestinal bleeding

M. Konečný^*, J. Ehrmann, V. Procházka, L. Válka, I. Vinklerová, I. Tozzi, K. Aiglová

II. interní klinika Lékařské fakulty UP a FN, Olomouc, přednosta prof. MUDr. Jiří Ehrmann, CSc.

Acute upper gastrointestinal bleeding is life-threatening condition with substantial incidence and relatively high mortality. The fundamental principle of the care for such patients is not only the hospitalisation with intensive monitoring of life functions, but especially the existence of multispecialty team, which must be the integrated unit in diagnostic and therapeutic procedure. For the sake of improving the quality of care for these patients it is necessary for such service to be centralised and organisationally supported by mandatory guideline in individual health facilities. In this frame the 2nd Internal Clinic of UH Olomouc was authorised to provide care for patients with GI diseases, liver and diabetes mellitus. The part of this care is also care for patients with acute bleeding to the digestive tract.

Objective: The evaluation of mortality and reduction of costs expended on treatment of patients with acute GI bleeding in centralised care. Patients population and methods: The authors monitored in the group of 831 individuals, admitted into UH Olomouc with signs of acute GI bleeding during 6-year period, whether the introduction of the integrated care for these patients resulted in the shortening of duration of hospitalisation, thereby in the reduction of economical burden and mortality.

Results: The mortality decreased by more than 2 % (5.6 % vs 3.4 %) after the centralisation of treatment and introduction of guideline on integrated care for these patients. The difference is statistically non-significant. The duration of treatment period decreased almost about 2 days and the demand for blood transfers was reduced by 0.7 transfusion unit, the difference being statistically significant.

Keywords: bleeding to the digestive tract; hematemesis; melena; enterorrhagia; ulcer disease

Received: January 23, 2004; Accepted: March 25, 2004; Published: January 1, 2005  Show citation