Abstract
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Abstract; Background Gastroenterologists of Mulago hospital noted that many patients with gastrointestinal bleeding are transferred to their ward from the emergency ward without adequate resuscitation. They recommended that blood should be ring fenced for patients with gastrointestinal bleeding (GI) on the emergency ward so that urgent resuscitation can be done. There was however no current data on the prevalence of GI bleeding in the emergency ward to provide a guide of how much blood should be ring fenced. This was partly because the medical records are not adequately completed as designed. We thus undertook a study to estimate the prevalence of GI bleeding on the emergency ward by incorporating quality improvement methods in the process of data collection to improve the documentation practice on the Casualty assessment form (CAF).Methods This was a cross sectional study incorporating quality improvement methods in the process of data collection from the CAF for patients attending the emergency ward. Focus group discussions and key informant interviews were conducted to ascertain the root causes of inadequate completion of this form. The health care team was educated on documentation of GI bleeding while being assessed weekly for knowledge and practice of completion of the CAF. The filled CAF were assessed for adequate completion while looking out for a documented diagnosis of GI bleeding and selected predictors of mortality.Results Of the 1881 CAF assessed, 278 had a documented diagnosis of GI bleeding, resulting in a prevalence of 6.8%. Of the patients with GI bleeding, 14.1% of them had age greater than 60 years old, 24.0% had a systolic blood pressure less than 100mmHg and 44.5% had a heart rate greater than 100 beats per minute.Conclusion The prevalence of GI bleeding on the medical emergency ward of Mulago hospital is high, with 1 in every 15 patients having this condition. This calls for strategies for resuscitative management of this potentially life threatening condition. Among the selected predictors of mortality, tachycardia was most frequent followed by hypotension. These should always be assessed in a patient with GI bleeding and resuscitative measures with blood transfusion and intravenous fluids undertaken to correct them.