P298 The optimisation of a local endoscopy GI bleed service utilising SNOMED CT

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Introduction The 2015 UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD) audit highlighted suboptimal acute upper gastrointestinal bleeding (AUGIB) management. Guidelines have attempted to define quality standards to improve outcomes, notably timely endoscopic management within the first 24 hours of admission. We therefore aimed to enhance identification of inpatient admissions related to AUGIB using SNOMED clinical terms (SNOMED CT). Methods Baseline snapshot data was collected of endoscopic management of inpatients presenting with AUGIB using our endoscopic database from April 2020 to March 2021. This showed deficiencies in the data set itself, as well as notable discrepancies, for example only 62 out of 127 patients who underwent upper GI endoscopies for suspected upper GI bleeding, had upper GI bleeding as a diagnosis. We created a set of pre-defined SNOMED CT to aid identification of patients presenting with AUGIB. SNOMED CT is a precise clinical IT system, providing a consistent clinical vocabulary for recording patient information across the NHS. The use of computerised clinical decision support is growing as an adjunct to enhance clinical practice. Using an inclusion criterion of older than 16 years old, from 01 April 2020 to 31 March 2021, 8 SNOMED codes were used to identify patients presenting with any symptoms or signs of upper GI bleeding from the ED database. We subsequently re-evaluated this new data set and compared it to our initial snapshot data from our endoscopic database. Results 91 patients were accurately identified using the novel pre-defined criteria; comparatively, only 35 of these patients were found using our previous identification method. 64 out of those 91 patients were scoped during their admission, and 51 out of 64 were scoped within 24 hours. There was appropriate clinical reasoning for all patients receiving a scope after 24 hours of admission. The two most significant reasons why patients were not scoped during the admission were either that they did not have significant evidence of a GI bleed or did not consent to the procedure. Overall results showed a significant improvement in accuracy and comprehension of the identification of AUGIB patients presenting to ED, and an enhanced data set to now evaluate for further quality improvement. Conclusions Our aims were achieved within two cycles of a quality improvement project, where we successfully created and optimised a pre-defined admission criteria to help risk stratify patients presenting with AUGIB using SNOMED CT. Recommendations include: regular medical education and quality improvement projects should occur regarding updates on endoscopic care standards so that endoscopic therapy can be performed in a timely manner to improve care outcomes.

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