NCEPOD report shows major shortfall in the care of GI bleed patients

The College acknowledges NCEPOD’s important study, ‘Time to Get Control’, a report calling for life-saving 24/7 access to gastrointestinal (GI) bleed services, including on-site critical care and anaesthesia.  The report highlights major deficiencies in the diagnosis and subsequent treatment of the condition, and says that without 24/7 access to GI bleed specialists, hospitals continue to put patients’ lives at risk.

With one of the stated aims of the study to ‘assess the use of escalated care and anaesthetic support for interventions’, the NCEPOD review concludes that many hospitals have no procedures to rapidly bring together specialist services for when a patient suffers a GI bleed. The report also found that only five of 42 emergency endoscopies were performed in endoscopy suites, suggesting they may not be appropriately equipped, staffed or located to provide general anaesthesia.  This raises major concerns for patient safety and the RCoA Guidelines for the Provision of Anaesthetic Services 2015 (GPAS) recommends that for high risk patients, including those with potential GI bleeding, a full general anaesthesia with rapid sequence induction and intubation in an operating theatre may be the safest option.

The NCEPOD study offers a number of recommendations, including that: Patients with any acute GI bleed should only be admitted to hospitals with 24/7 access to: on-site endoscopy; interventional radiology (on-site or covered by a formal network); on-site GI bleed surgery; and on-site critical care and anaesthesia.

The report also recommends that consideration needs to be given to developing a combined guideline for all GI bleeding to include existing NICE guidelines and to be led by the BSG and NICE and to include, but not limited to, RCoA, ICS, FICM, AAGBI, SIGN, RCR, BSIR, ASGBI.  The College welcomes the opportunity to work with colleagues to address concerns, define ‘major/severe’ GI bleeding and to develop a definitive set of guidelines to improve patient care.  The College has worked with the BSG to produce Guidance for the use of propofol sedation for adult patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and other complex upper GI endoscopic procedures.

03 July 2015