1293 Audit of Initial Management of Lower Gastrointestinal Bleeding as per the British Society of Gastroenterology Guidelines

This is the authors' abstract. We don't add key points for this paper.

Introduction Lower gastrointestinal (LGI) bleeding is a frequent presentation to acute surgical teams. It can range in severity from mild to life-threatening, and most commonly presents with haematochezia. This data explores the implementation of the British Society of Gastroenterology’s guidelines at a District General Hospital lacking a management pathway for LGI bleeding. Method Data was collected on all patients presenting to the Emergency Department with per rectal (PR) bleeding. This was retrospectively collected from July to August 2023. Data collected included shock index at presentation, details for Oakland Scoring, hospital admission, complications, and follow up. Results All minor LGI bleeds (Oakland score of ≤8) were discharged with no readmission within 28 days. In July, four of 45 major bleeds were unstable, with one undergoing CT angiogram, compared to two of 27 in October with one undergoing CT angiogram. Of the 45 major bleeds in July, 32 were admitted (71.1%) and 13 were discharged (28.9 %), 5 without endoscopy. In October, 15 of 27 major bleeds were admitted (55.6%) and 12 discharged (44.4%), all with endoscopy. In July, three patients (23.1%) were re-admitted within 28 days, compared to one patient (8.3%) in October. Conclusions Despite integration efforts, there was minimal improvement in Oakland Scoring compliance, with many major LGI patients discharged. Nonetheless, all major bleed patients in cycle 2 had follow-up endoscopy organised and fewer patients were readmitted. This study could be improved upon with improved integration efforts for Oakland Scoring and Shock Index, such as providing the algorithm in a portable online format.