Upper GI bleeding
Dr Richard Ingram

Dr Richard Ingram – 2017 BSG-Guts UK Trainee Research Network Award

Institution: Nottingham University Hospitals NHS Trust/WMRIG and GARNet SpR Trainee Networks

Title: About bleeding time: driving improvements in the quality of care received by patients with acute upper gastrointestinal bleeding using the GIBsix care bundle

Project Start Date: 15th January 2018

Completion Date: 14th January 2019


This exciting project is looking at the quality of care received by patients who suffer an acute upper gastrointestinal bleed. Gastrointestinal (GI) bleeding is a common medical emergency, with one person affected every six minutes in the UK. Mortality rate can be as high as 10% so it is essential that the medical guidelines, which instruct early management and timely endoscopy, are followed precisely. However, concerns have been raised about variation in practice and instances of suboptimal care of GI bleeding.

For this project the gastroenterology trainees from the East Midlands (GARNet www.thegarnet.org) and West Midlands (WMRIG www.wmrig.co.uk) networks have teamed up to carry out an audit of the care received by patients in the hospitals they work in. Ten hospitals have already signed up to the project and another 6 plan to join in as the project is rolled out. The trainees will assess the care provided and will also introduce a new, easy-to-use, evidence-base, checklist of six actions that have been shown to improve outcomes for patients. This checklist (a ‘care bundle’ known as GIBsix) contains the ‘six-Rs’ in the early management of GI bleeding: Recognition, Resuscitation, Risk assessment, Rx (treatment),  Refer for further management (including endoscopy), and Right ward for ongoing care. This GIBsix care bundle is meant to sit alongside the hospital’s own policies and guidelines for the management of GI bleeding, and help Emergency Departments, general wards and Gastroenterology teams deliver better care. Similar ‘care bundles’ have been shown to achieve this, such as the ‘sepsis six bundle’ adopted as part of the national Surviving Sepsis campaign. The trainees hope that the GIBsix care bundle will also be adopted nationally and bring similar long-awaited improvements in the care of patients with GI bleeds. The trainees were involved in developing the care bundle and in their own words: ‘We want to lead on its initial implementation, validation and further refinement. We will also ask patients and hospital staff what else we can do.

The project will also allow the trainees to establish collaborations across the regions and to share best practice. The project will engage a large number of trainees, providing them with training and experience of working in multi-site clinical projects. This will support the development of an NHS workforce that can design and deliver such projects. The trainees are also keen to involve patients and the public in the future expansion of the GIBsix and potentially work with Guts UK to support patient advocates that can share the project findings with other hospitals.

Scientific publications from this research

Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee-led audit

A call to arms for change: The UK strategy to improve standards of care in acute upper gastrointestinal bleeding

We are delighted to receive Guts UK's support to carry out this important work. The initiative to develop a checklist of actions to improve quality of care in GI bleeding originated was a trainee-led idea stemming from the Midlands. We are keen and excited to be able to develop it further, involving patients and hospital staff in the process.

Dr Richard Ingram