Trends in compliance with the BSG acute upper gastrointestinal bleeding care bundle at a district general hospital: A four-cycle retrospective audit (2020-2025)

Title : Trends in compliance with the BSG acute upper gastrointestinal bleeding care bundle at a district general hospital: A four-cycle retrospective audit (2020-2025)

Abstract:

Introduction: Acute Upper Gastrointestinal Bleeding (AUGIB) is a common medical emergency with a 30-day mortality of up to 10%. The British Society of Gastroenterology (BSG) AUGIB consensus care bundle standardises management across six domains: Recognition, Resuscitation, Risk Assessment, Treatment, Referral, and Review. Compliance with this bundle at District General Hospital (DGH) level has not been well characterised longitudinally.

Aims & Methods: We conducted a four-cycle retrospective audit at Milton Keynes University Hospital (MKUH) from 2020 to 2025 to track compliance trends and identify persistent gaps in care. Retrospective four-cycle audit at MKUH (2020 April–Aug [n=50], 2023 Jul–Aug [n=34], 2024 Mar–Jun [n=45], 2025 Mar–Apr [n=37]). Records reviewed electronically (eCARE/EDM/ICE). Compliance is measured against all BSG bundle items across six domains. Clinically cancelled OGDs and repeated OGDs were excluded from the timeliness analysis.

Results: GBS documentation improved from 4% (2020) to 91.9% (2025). Antithrombotic resumption planning rose from 16% to 100%. RBC transfusion compliance improved from 32% to 100%. OGD within 24 hours improved from 44.1% (2023) to 86.4% (2025), with persistent Friday/weekend delays. IV crystalloid administration remained variable (48%→79.4%→57.8%→80%). Terlipressin use in variceal bleeding fluctuated (80%→55.5%→44.4%→80%). NEWS and antithrombotic interruption achieved 100% throughout. 30-day mortality: 5 in 2024 (comorbidity-related); 0 in 2025.

Conclusion: A four-cycle retrospective audit demonstrates improving compliance with the BSG AUGIB care bundle at a UK district general hospital. Sustained gains in risk stratification, transfusion practice, and antithrombotic management coexist with persistent gaps in IV fluid administration, Terlipressin use, and OGD timeliness. Iterative audit cycles are an effective quality improvement tool.

Limitations: Retrospective cross-sectional design; varying sample sizes; compliance reflects documentation rather than practice.

Biography:

Moses G. Ogundipe MBChB (Hons) is a Foundation Year 1 Resident Doctor in General Internal Medicine at Northampton General Hospital NHS Trust. He graduated from the University of Buckingham Medical School with Honours, having achieved distinctions throughout his medical training. During his medical school placement at Milton Keynes University Hospital, Moses contributed to a multi-cycle clinical audit on the management of Acute Upper Gastrointestinal Bleeding, benchmarked against the BSG AUGIB Care Bundle. He has a broader interest in quality improvement and clinical research, with additional work in cardiovascular medicine and toxicology. Moses is pursuing a career in critical care and pulmonology.