International Journal for Quality in Health Care Advance Access originally published online on March 10, 2005
International Journal for Quality in Health Care 2005 17(3):249-254; doi:10.1093/intqhc/mzi023
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Post-endoscopy checklist reduces length of stay for non-variceal upper gastrointestinal bleeding
Department of Medicine (Divisions of 1 Gastroenterology and 4 Pulmonary Medicine), 2 Department of Community Health Sciences, 6 Family and 7 Emergency Medicine, 5 Quality Improvement Measurement and Evaluation, and 8 Endoscopy Nursing Management, Calgary Health Region and University of Calgary, Calgary, Alberta, Canada; 3 Department of Medicine (Division of Gastroenterology and Hepatology), Medical University of South Carolina, Charleston, SC, USA
Objective. To examine the effect of improved gastroenterologist-to-admitting service communication on hospital stay for upper gastrointestinal bleeding. Hypothesis: a detailed checklist addressing factors relevant to discharge planning would shorten hospital stay, when added to the procedure report.
Design. Pre–post intervention design, recording balance measures (potential confounders).
Setting. A Canadian university hospital.
Study participants. Intermittent 5- to 7-day batches of consecutive emergency patients presenting with non-variceal upper gastrointestinal bleeding as their primary problem. The durations of the background and intervention periods were 3 months (beginning 9 June 2003) and 4 weeks (beginning 8 September 2003), respectively.
Intervention. The gastrointestinal bleeding Quality Improvement and Health Information multidisciplinary team (quality improvement personnel; emergency physicians, hospitalists, gastroenterologists, in-patient and endoscopy nurses) developed a one-page checklist, outlining detailed recommendations (3-Ds—diet, drugs, discharge plan) to append to the procedure report.
Main outcome measures. Difference in median length of hospital stay was the primary endpoint. As balance measures, demographics, bleeding severity, comorbidities, readmission rates, and various benchmark times were recorded prospectively.
Results. Thirty-nine patients met the criteria in the background period (4 months, intermittently sampled), and 22 in the intervention period (4 weeks, continuously sampled). There were no significant baseline differences. Median in-patient stay was 7.0 (95% interquartile range 2–24) versus 3.5 (95% interquartile range 1–12) days for the background and intervention periods, respectively (P = 0.003). This remained significant when outliers (stay > 10 days) were removed (P = 0.02).
Conclusion. A checklist, with very specific recommendations to the admitting service, significantly reduced hospital stay for non-variceal gastrointestinal bleeding.
Keywords: Quality assurance/improvement, length of stay, economics, upper gastrointestinal bleeding, patient care maps
Address reprint requests to Joseph Romagnuolo, MUSC, Medical University of South Carolina, Gastroentrology & Hepatology, 96 Jonathan Lucus Street, Ste 210, PO Box 250327, Charleston, SC29425. E-mail: romagnuo{at}musc.edu
Accepted for publication January 5, 2005.