Adherence to institutional clinical practice guideline on managing upper gastrointestinal bleeding, in a hospital in Lima - Peru

• Published in: Revista de gastroenterología del Perú Vol. 40; no. 2; pp. 115 - 126
• Main Authors: Benites-Goñi, Harold, Brañez-Condorena, Ana, Monge-Del Valle, Fiorella, Medina-Morales, Bryan, Cárdenas-Vela, Irene, Asencios-Cusihuallpa, Jairo, Castillo-Plasencia, César, Bardalez-Cruz, Paulo, Dávalos-Moscol, Milagros, Taype-Rondan, Alvaro
• Format: Journal Article
• Language: Spanish
• Published: 01.04.2020
• ISSN: 1609-722X

INTRODUCTIONIn 2018, the Clinical Practice Guideline (CPG) for the Evaluation and Management of upper gastrointestinal bleeding (UGB) was published by the Social Security of Peru (EsSalud). It provides evidence-based statements to optimize the management of these patients. OBJECTIVETo evaluate the adherence to the statements of the CPG at the Edgardo Rebagliati Martins National Hospital (HNERM) of EsSalud (Lima, Peru). MATERIALS AND METHODSRetrospective study, which analyzed the database of all patients who came to the HNERM emergency service with suspected UGB and were scheduled for endoscopy between October 19, 2019 and April 15, 2020. We included those with ≥ 18 years of age. This database contains the main characteristics of the standardized medical history for patients with UGB. Compliance with 13 of the 34 statements of the EsSalud CPG was evaluated. The results were presented descriptively, and the factors associated with compliance with the statements with insufficient adherence (<80%) and with more than 100 evaluated participants were evaluated. RESULTSData were obtained from 184 patients who met the inclusion criteria (men: 59.8%, median age: 70 years). The range of adherence to the 13 statements was from 63.2% to 99.5%. Only two statements had insufficient adherence (<80%). The statement with the least adherence was the recommendation to perform a restrictive transfusion. Noncompliance with this recommendation was found to be lower in those who had a higher score on the Glasgow-Blatchford index, a urea creatinine ratio > 60, and a lower hemoglobin on admission. CONCLUSIONOf the 13 statements evaluated, 11 had satisfactory adherence. It is important to explore the reasons why adherence is not adequate for some statements, and to evaluate methods to increase this adherence.