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Upper GI haemorrhage

Start this sheet when: Haematemesis, coffee-ground vomit or melaena, or fresh rectal bleeding with shock. Anyone with known liver disease or alcohol use: treat as variceal until endoscopy says otherwise.

Hospital (remembered on this device)Patient ID / UHID (not saved)Age / SexFilled by

Door dateDoor time (clock starts here)

Time since door

Targets met --Breaches 0

1.Triage, shock index checked (HR / SBP)
≤ 5 min from door · ED KPI: triage median 5 min
Enter door time
2.Two large-bore cannulas, group and crossmatch sent
≤ 15 min from door · Local target: in the first 15 min
Enter door time
3.Glasgow-Blatchford score documented
≤ 1 h from door · NICE CG141: score at first assessment
Enter door time
4.Transfusion started (Hb below 7, or 8 with heart disease, or shock)(Needs blood)
≤ 30 min from door · Local target: MTP if still shocked
N/AEnter door time
5.Terlipressin (or octreotide) given(Suspected variceal bleed)
≤ 30 min from door · Baveno VII: as soon as varices suspected
N/AEnter door time
6.Ceftriaxone 1 g given(Cirrhosis)
≤ 1 h from door · Baveno VII: antibiotic prophylaxis in cirrhosis
N/AEnter door time
7.Endoscopy done (variceal or unstable after resus)(Variceal or high-risk)
≤ 12 h from door · Baveno VII / ESGE 2021: within 12 h
N/AEnter door time
8.Endoscopy done (stable, non-variceal)(Stable, admitted)
≤ 24 h from door · NICE CG141 / ESGE 2021: within 24 h
N/AEnter door time
9.Disposition decided
Record · Admit / transfer / OT; for the length-of-stay audit
Enter door time
10.Patient left the ED
≤ 2 h from disposition decision · ED KPI: decision to departure 2 h or less
Enter door time

Bedside checklist

☐GBS 0-1: safe for early discharge with outpatient endoscopy
☐Restrictive: target Hb 7-9 (7-8 in varices); overfilling re-bleeds varices
☐Stop and reverse anticoagulants; hold antiplatelets after cardiology word
☐PPI never replaces or delays endoscopy; high dose after ulcer therapy
☐Erythromycin 250 mg IV 30-90 min before scope if blood in stomach
☐Airway protection before endoscopy if vomiting blood with low GCS
☐Balloon tamponade only as a bridge, max 24 h, intubate first
☐Lower GI bleed with shock: CT angiogram before colonoscopy

References

Targets marked “local” are suggestions: agree your own with the quality committee before auditing against them.

Bedside checklist

☐GBS 0-1: safe for early discharge with outpatient endoscopy

☐Restrictive: target Hb 7-9 (7-8 in varices); overfilling re-bleeds varices

☐Stop and reverse anticoagulants; hold antiplatelets after cardiology word

☐PPI never replaces or delays endoscopy; high dose after ulcer therapy

☐Erythromycin 250 mg IV 30-90 min before scope if blood in stomach

☐Airway protection before endoscopy if vomiting blood with low GCS

☐Balloon tamponade only as a bridge, max 24 h, intubate first

☐Lower GI bleed with shock: CT angiogram before colonoscopy