From the Division of Pediatric Gastroenterology, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI.
the Center for Bleeding and Clotting Disorders, Michigan State University College of Human Medicine, East Lansing, MI.
J Pediatr Gastroenterol Nutr. 2023 Nov 1;77(5):661-665. doi: 10.1097/MPG.0000000000003929. Epub 2023 Oct 27.
Gastrointestinal (GI) endoscopic procedures are considered low risk with an overall bleeding risk for upper and lower endoscopies of 0.11%. However, a certain population of patients may have a higher risk for bleeding, and there is not a standardized process for screening patients to determine who these patients are.
At Children's Wisconsin, our gastroenterology and hematology divisions adapted an abbreviated version of a validated, history-based bleeding risk screening tool and implemented a hematology referral process to identify those at risk for bleeding prior to their first endoscopy. Provider compliance with the bleeding screen, referral to hematology, time to be seen in hematology clinic, new diagnoses of bleeding disorders, and bleeding complications were assessed from 2019 to 2021 across 3 phases.
Provider compliance with the bleeding screen improved throughout our study from 48% (120/251) to 75% (189/253). For those who screened positive, compliance with referral to hematology ranged from 38% to 74% across our phases. The overall time to be seen by hematology decreased from 30 days to 7.5 days. Eighteen patients ultimately screened positive and were seen in hematology clinic, of whom 22% (4/18) were diagnosed with a new bleeding disorder. No bleeding complications were seen in our study population.
Our quality improvement project provided a standardized screening tool to assess preoperative bleeding risk and reinforced the value of a history-based screening tool. This modified screening tool identified those with an undiagnosed bleeding disorder and preventative measures were undertaken to prevent procedural bleeding complications.
胃肠（GI）内镜检查被认为风险较低，上消化道和下消化道内镜检查的总体出血风险为 0.11%。然而，某些患者群体可能有更高的出血风险，目前尚无标准化的筛选流程来确定这些患者。
在威斯康星儿童医院，我们的胃肠病学和血液科采用了经过验证的简化版基于病史的出血风险筛查工具，并实施了血液科转诊流程，以便在首次内镜检查前识别出有出血风险的患者。我们评估了 2019 年至 2021 年期间三个阶段提供者对出血筛查、转血液科、在血液科就诊的时间、新诊断的出血性疾病和出血并发症的依从性。
在整个研究过程中，提供者对出血筛查的依从性从 48%（120/251）提高到 75%（189/253）。对于筛查阳性的患者，转诊到血液科的依从性在我们的各阶段从 38%到 74%不等。总体而言，到血液科就诊的时间从 30 天缩短到 7.5 天。最终有 18 名患者筛查阳性并在血液科就诊，其中 22%（4/18）被诊断为新的出血性疾病。在我们的研究人群中未发生出血并发症。
我们的质量改进项目提供了一种标准化的筛查工具来评估术前出血风险，并强化了基于病史的筛查工具的价值。这种改良的筛查工具确定了那些患有未诊断出血性疾病的患者，并采取了预防措施来预防手术出血并发症。
