Quality statement 1: Risk assessment

Quality statement

People with acute upper gastrointestinal bleeding receive a risk assessment using a validated risk score.

Rationale

The prognosis for people with acute upper gastrointestinal bleeding can vary so it is important to carry out a risk assessment using a validated risk score. This can inform the best course of further treatment, and in some instances can identify people for whom early discharge or outpatient endoscopy are appropriate.

Quality measures

Structure

Evidence of local arrangements to ensure that people with acute upper gastrointestinal bleeding receive a risk assessment using a validated risk score.

Data source: Local data collection.

Process

Proportion of people with acute upper gastrointestinal bleeding who receive a risk assessment using a validated risk score.

Numerator – the number of people in the denominator who receive a risk assessment using a validated risk score.

Denominator – the number of people with acute upper gastrointestinal bleeding.

Data source: Local data collection. Contained in NICE audit support for Acute upper gastrointestinal bleeding: initial management (NICE clinical guideline 141). The British Society of Gastroenterology's UK comparative audit of upper gastrointestinal bleeding and the use of blood (2007) asks, 'Does your hospital routinely calculate and document a risk score (for example, Rockall or Blatchford scores) for patients with suspected upper GI bleeding?'

What the quality statement means for service providers, healthcare practitioners, and commissioners

Service providers ensure that systems are in place for people with acute upper gastrointestinal bleeding to receive a risk assessment using a validated risk score.

Healthcare practitioners give people with acute upper gastrointestinal bleeding a risk assessment using a validated risk score.

Commissioners ensure that they commission services that give people with acute upper gastrointestinal bleeding a risk assessment using a validated risk score.

What the quality statement means for patients, service users and carers

People with acute upper gastrointestinal bleeding have an assessment of their risk of more bleeding or complications, using an accepted scoring system.

Source guidance

  • Acute upper gastrointestinal bleeding: management (NICE clinical guideline 141), recommendations 1.1.1 (key priority for implementation) and 1.1.2.

Definitions of terms used in this quality statement

Risk assessment NICE clinical guideline 141 recommendations 1.1.1 and 1.1.2 suggest the following approach for risk assessment:

Use the following formal risk assessment scores for all patients with acute upper gastrointestinal bleeding:

  • the Blatchford score at first assessment, and

  • the full Rockall score after endoscopy.

Consider early discharge for patients with a pre-endoscopy Blatchford score of 0.