Evaluating the Safety and Effectiveness of Regional Upper GI Bleed Services Through an Outcome-Based Analysis at a Centre in the United Kingdom

Background The aim of this study was to compare the clinical characteristics and clinical outcomes of patients who presented with acute upper gastrointestinal bleeding (AUGIB) among two groups of patients who were transferred from local and district hospitals for endoscopy and subsequent management versus direct admissions to the emergency department with AUGIB to the Sheffield University Hospital NHS Trust. Methods We included 259 patients who underwent upper GI endoscopy from April 2018 to March 2022, of whom 29 were transferred and 230 were direct admissions. The analysis focused on demographics, pathological findings, time to endoscopy, blood transfusions, and hospital stay. Results The transferred patients were younger (median age 58 vs. 67 years) and received early endoscopic interventions compared to direct admissions (mean time to endoscopy 0.97 vs 2.1 days/p=0.001). The means (s.d.) of hospital stay among the transferred and direct admission groups were 9.9 (9.5) and 8.3 (9.7) days, respectively (p=0.43), regardless of intervention timing or transfusion needs. The timing of the procedure did not influence the length of hospital stay from the time of endoscopy to discharge (p=0.241). Thirty-day mortality was 8 (28%) in the transferred group and 20 (9%) in the non-transferred group (p=0.006). Conclusion These findings underscore that regional bleeding services are safe and effective.