Faculty Collaboration Database

Implementation of a Bleeding Risk Screening Tool and Hematology Referral Process Prior to Pediatric Endoscopy. J Pediatr Gastroenterol Nutr 2023 Nov 01;77(5):661-665

Date

08/23/2023

Pubmed ID

37608441

DOI

10.1097/MPG.0000000000003929

Scopus ID

2-s2.0-85175355904 (requires institutional sign-in at Scopus site)

Abstract

OBJECTIVES: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Author List

McSorley B, Chugh A, Abazi T, Lerner D, Jobe S, Pan AY, Zhang L, Sharma R, Ashai-Khan F

Authors

Ankur A. Chugh MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Diana Lerner MD Professor in the Pediatrics department at Medical College of Wisconsin
Amy Y. Pan PhD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Blood Coagulation Disorders
Child
Endoscopy, Gastrointestinal
Hematology
Hemorrhage
Humans
Referral and Consultation