Evaluating the process of care in nonvariceal upper gastrointestinal haemorrhage: a survey of expert vs. non-expert gastroenterologists

Alimentary Pharmacology & Therapeutics
Eric EsrailianBrennan M R Spiegel

Abstract

When faced with the same facts, physicians often make different decisions. Aim To perform a survey to measure the process of care and variations in decision-making in nonvariceal upper gastrointestinal tract haemorrhage (NVUGIH) and compare results between experts and non-experts. We administered a vignette survey to elicit knowledge and beliefs about NVUGIH, including 13 'best practice' guidelines. We compared guideline compliance between experts and non-experts. One hundred and eighty-eight gastroenterologists responded (46%). Experts endorsed more 'best practices' than non-experts (93% vs. 85%; P = 0.002). Non-experts were more likely to endorse incorrectly bolus dosing vs. continuous infusion of intravenous proton pump inhibitors (PPIs; 92% vs. 64%; P = 0.005) and to select standard-channel vs. large-channel endoscopes in high-risk bleeding (100% vs. 85%; P = 0.04). There were wide variations within groups regarding the timing of nasogastric lavage, use of promotility agents, use of hemoclips and appropriateness of snaring clots overlying ulcers. Experts are more likely to comply with NVUGIH guidelines. Non-experts diverge from experts in the dosing of PPIs and choice of endoscope in high-risk bleeding. Moreover, there are ...Continue Reading

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Citations

Apr 3, 2009·Clinical Journal of the American Society of Nephrology : CJASN·Amar A DesaiBrennan M R Spiegel
Oct 29, 2011·Gastrointestinal Endoscopy·Daniel J Pallin, John R Saltzman
Oct 18, 2011·Gastroenterología y hepatología·Francisco José Martínez CerezoCristina Manso
Jul 9, 2011·Gastrointestinal Endoscopy·Edward S HuangBrennan M Spiegel
Apr 24, 2017·Journal of Investigative Medicine : the Official Publication of the American Federation for Clinical Research·Don C RockeyJoan S Reisch
Nov 25, 2011·European Journal of Gastroenterology & Hepatology·Conor LahiffDermot O'Toole

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