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<< Gastrointestinal Bleeding: An Evidence-Based ED Approach To Risk Stratification

Cost- And Time-Effective Strategies For Patients With GI Bleeding

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Cost- And Time-Effective Strategies For Patients With GI Bleeding

Cost- And Time-Effective Strategies For Patients With GI Bleeding

1. Effective risk stratification is key.

Understanding risk stratification is critical to the costeffective ED management of GI bleeding. (See Table 1) The cost of admission may be altogether avoided in very low-risk patients. Appropriate ordering of blood bank specimens, such as ordering a type and hold instead of a type and cross in low-risk patients, offers some cost savings without placing patients at increased risk.

2. Early endoscopy saves time and money.

Early endoscopy is associated with an overall lower cost of care, shortened hospital stays, and improved outcomes.15,107,108 Although there is some inherent cost in having endoscopy performed in the ED, this may be much less expensive than admitting a patient directly to the  hospital to await endoscopy. Some patients may be discharged directly home after endoscopy is performed in the ED.

3. Early pharmacologic therapy may result in significant savings.

Initiation of acid-blocking therapies has been shown to reduce the risk of rebleeding and thereby provide a potential long-term cost savings. In the short term, IV infusion of high-dose omeprazole in the first 72 hours after presentation to the ED may be cost-effective. One study found that averting a single episode of recurrent bleeding after initial hemostasis was achieved endoscopically is associated with over $1000 of cost savings per patient.138

Publication Information

John L. Westhoff; Kurtis R. Holt

Publication Date

March 1, 2004

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