Introduction

Approximately 70 000 patients are admitted to hospital each year in the UK because of acute upper gastrointestinal (UGI) bleeding, of whom 1 in 10 die as a direct result of bleeding. In recent years, there has been a revolution in the management of these patients, using endoscopic treatment of ulcer bleeding by injection, coagulation, or clipping and of varices by banding or gluing. When these measures are unsuccessful, trans-arterial embolisation may stop ulcer bleeding while TIPS may arrest bleeding from varices. Clearly the earlier these treatments can be applied in actively bleeding patients the better.

The evidence base for managing acute UGI bleeding is well established and forms the basis of current guidelines.1 2 In the large audit undertaken by the National Blood Service and the British Society of Gastroenterology it was found that not all units comply with guideline recommendations. Furthermore, while 60% of admissions for UGI bleeding in the UK occur out of normal working hours, only 55% of hospitals provided an out-of-hours emergency endoscopy service. Access to emergency interventional radiology is even more limited. There is therefore a large gap between published recommendations and the actual levels of service provision across the UK.

The Scope for Improvement project aspired to define a range of service arrangements to manage patients presenting with UGI bleeding. The report can be used by hospitals to support re-design of services to provide 24/7 diagnosis and management for patients developing UGI bleeding. It can be accessed at http://aomrc.org.uk/projects/upper-gastrointestinal-bleeding-toolkit.html. This paper describes the development and key recommendations of the Scope for Improvement project.