Siau Keith, Hearnshaw Sarah, Stanley Adrian J, Estcourt Lise, Rasheed Ashraf, Walden Andrew, Thoufeeq Mo, Donnelly Mhairi, Drummond Russell, Veitch Andrew M, Ishaq Sauid, Morris Allan John
Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.
Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Frontline Gastroenterol. 2020 Mar 27;11(4):311-323. doi: 10.1136/flgastro-2019-101395. eCollection 2020.
Medical care bundles improve standards of care and patient outcomes. Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency which has been consistently associated with suboptimal care. We aimed to develop a multisociety care bundle centred on the early management of AUGIB. Commissioned by the British Society of Gastroenterology (BSG), a UK multisociety task force was assembled to produce an evidence-based and consensus-based care bundle detailing key interventions to be performed within 24 hours of presentation with AUGIB. A modified Delphi process was conducted with stakeholder representation from BSG, Association of Upper Gastrointestinal Surgeons, Society for Acute Medicine and the National Blood Transfusion Service of the UK. A formal literature search was conducted and international AUGIB guidelines reviewed. Evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation tool and statements were formulated and subjected to anonymous electronic voting to achieve consensus. Accepted statements were eligible for incorporation into the final bundle after a separate round of voting. The final version of the care bundle was reviewed by the BSG Clinical Services and Standards Committee and approved by all stakeholder groups. Consensus was reached on 19 statements; these culminated in 14 corresponding care bundle items, contained within 6 management domains: Recognition, Resuscitation, Risk assessment, Rx (Treatment), Refer and Review. A multisociety care bundle for AUGIB has been developed to facilitate timely delivery of evidence-based interventions and drive quality improvement and patient outcomes in AUGIB.
医疗护理集束可提高护理标准及患者治疗效果。急性上消化道出血（AUGIB）是一种常见的医疗急症，一直与护理欠佳相关。我们旨在制定一个以AUGIB早期管理为核心的多学会护理集束。在英国胃肠病学会（BSG）的委托下，组建了一个英国多学会特别工作组，以制定一个基于证据和共识的护理集束，详细列出在AUGIB就诊后24小时内要进行的关键干预措施。与来自BSG、上消化道外科医生协会、急性医学学会和英国国家输血服务机构的利益相关者代表进行了改良德尔菲法流程。进行了正式的文献检索并对国际AUGIB指南进行了审查。使用推荐分级、评估、制定和评价工具对证据进行评估，并制定声明并进行匿名电子投票以达成共识。在另一轮投票后，被接受的声明有资格纳入最终集束。护理集束的最终版本由BSG临床服务和标准委员会审查，并得到所有利益相关者团体的批准。就19项声明达成了共识；这些声明最终形成了14项相应的护理集束项目，并包含在6个管理领域中：识别、复苏、风险评估、治疗（Rx）、转诊和复查。已制定了AUGIB的多学会护理集束，以促进及时提供基于证据的干预措施，并推动AUGIB的质量改进和患者治疗效果。
