Auditing mortality from upper gastrointestinal haemorrhage: impact of a high dependency unit.
BACKGROUND: A retrospective audit conducted at our district general hospital indicated that mortality from upper gastrointestinal (GI) haemorrhage was above that reported from nearby centres. OBJECTIVES: To assess 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 established inpatients with haematemesis and/or melaena, were examined for fitness for endoscopy, comorbidity, underlying diagnosis and the need for surgery. SUBJECT: Over a two-year period, 524 patients were studied in the two audits. Risk scores were calculated and the 30-day mortality from all causes assessed. RESULTS: There was a trend towards higher age and comorbidity during the second audit. Mortality was 9% and 10% during the first and second audits, respectively. CONCLUSIONS: An increasing proportion of patients with bleeding are elderly and have associated comorbidity. Establishment of an HDU and agreed protocol did not reduce mortality at our centre.