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International Journal for Quality in Health Care Advance Access published online on March 10, 2005
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzi023
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International Journal for Quality in Health Care © International Society for Quality in Health Care and Oxford University Press 2005; all rights reserved
Accepted January 5, 2005

Article

Post-endoscopy checklist reduces length of stay for non-variceal upper gastrointestinal bleeding

Joseph Romagnuolo 1*, W. W. Flemons 2, Linda Perkins 3, Linda Lutz 3, Peter C. Jamieson 4, Carrie A. Hiscock 5, Lynda Foley 6, and Jon B. Meddings 7

1 Department of Medicine (Division of Gastroenterology), Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine (Division of Gastroenterology and Hepatology), Medical University of South Carolina, Charleston, SC, USA
2 Department of Medicine (Division of Pulmonary Medicine), University of Calgary, Calgary, Alberta, Canada
3 Quality Improvement Measurement and Evaluation, University of Calgary, Calgary, Alberta, Canada
4 Family Medicine, University of Calgary, Calgary, Alberta, Canada
5 Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
6 Endoscopy Nursing Management, Calgary Health Region, University of Calgary, Calgary, Alberta, Canada
7 Department of Medicine (Division of Gastroenterology), University of Calgary, Calgary, Alberta, Canada

* To whom correspondence should be addressed.
Joseph Romagnuolo, E-mail: romagnuo{at}musc.edu


  Abstract

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.
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