Quality Standards
Issued: July 2013
QS38

Acute upper gastrointestinal bleeding

Introduction

This quality standard covers the management of acute upper gastrointestinal bleeding in adults and young people (16 years and older). For more information see the acute upper gastrointestinal bleeding scope.

Why this quality standard is needed

Acute upper gastrointestinal bleeding is a common medical emergency that has a 10% hospital mortality rate. People with acute upper gastrointestinal bleeding develop haematemesis (vomiting of blood from the upper gastrointestinal tract) or melaena (black tarry stools). The most common causes are peptic ulcer and oesophagogastric varices. Although crude hospital mortality of acute upper gastrointestinal bleeding has not improved much over several decades, patients are now older and have many more comorbidities than in the past. In addition, the number of people with variceal bleeding has increased greatly as a consequence of alcohol misuse and obesity. The stable hospital mortality rate in the face of the increased incidence shows that management of acute upper gastrointestinal bleeding has improved substantially.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measureable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2013/14

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicator

1a Potential years of life lost (PYLL) from causes considered amenable to healthcare

i Adults ii Children and young people

1b Life expectancy at 75

i Males ii Females

3 Helping people to recover from episodes of ill health or following injury

Overarching indicator

3b Emergency readmissions within 30 days of discharge from hospital*

Alignment across the health and social care system

* Indicator shared with Public Health Outcomes Framework (PHOF)

Table 2 Public health outcomes framework for England, 2013–2016

Domain

Objectives and indicators

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicators

4.11 Emergency readmissions within 30 days of discharge from hospital (Placeholder)

Coordinated services

The quality standard for acute upper gastrointestinal bleeding specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole acute upper gastrointestinal bleeding care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to adults and young people (16 years and older) with acute upper gastrointestinal bleeding.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality acute upper gastrointestinal bleeding service are listed in Related NICE quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare practitioners involved in assessing, caring for and treating people with acute upper gastrointestinal bleeding should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.