808 Whose Problem Is the Lower Gastrointestinal Bleed? a Surgical or Medical Admission. - Exploring the Management and Diagnosis of Patients Admitted with a Lower Gastrointestinal Bleeds in a District General Hospital (DGH)

Abstract Aim Lower Gastrointestinal bleeds (LGIB) are a common presentation, with a 10% 1-year prevalence in the UK. The 2015 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report highlighted a deficiency into the care of this patient group. With subsequent guidelines from The British Society of Gastroenterology (BSG) calling for a multi-disciplinary approach to care. Nevertheless, the admitting speciality for LGIB is an area of contention and differs across trusts. Method A Retrospective Audit was carried out in a local DGH, exploring the management and diagnosis of LGIB. Clinical practice was compared to BSG standards, admissions under the medical teams and surgical teams explored and comparisons made. Results Over a four-month period; the data of 160 patients was collected. Patients presenting as outpatients, with upper gastrointestinal bleeds and with other primary complaints were excluded from the study, leaving 33 patients for analysis. Conclusions 74% of these patients were admitted under the medical team, with 17% of these needing an inpatient colonoscopy, all performed by Gastroenterologists. Of the 26% admitted under the surgical team, all had outpatient investigations booked, but none required inpatient scopes or surgical management. Despite preconceived ideas, most patients within this study were admitted under medical teams with little surgical input. An MDT approach to this cohort of patients is integral to care, however, consistency and clear pathways are needed to ensure ‘gold-standard’ care. The next steps of this project have included reviewing trust guidelines, discussions between medical and surgical teams alike, and further education.