Development of a Clinical Practice Guideline for the Management of Upper Gastrointestinal Bleeding at Trakan Phuet Phon Hospital

Abstract

Background: Upper gastrointestinal bleeding (UGIB) poses a life-threatening emergency, especially in small general hospitals with limited resources. This study aimed to identify existing challenges and develop a clinical practice guideline (CPG) for managing UGIB patients at Trakan Phuet Phon Hospital.

Methods: This action research study employed the Planning–Action–Observation–Reflection cycle over two iterations, incorporating Evidence-Based Practice alongside the Donabedian (Structure–Process–Outcome) framework. The participants comprised 30 multidisciplinary staff members and 60 patients with UGIB who presented to the emergency department (ED). The research instruments included a CPG compliance form, a time record form, a safe transfer checklist, an adverse event record form, and a satisfaction questionnaire. Quantitative data were analyzed using descriptive statistics, paired t-tests, and Chi-square tests (p < .05), while qualitative data were examined through content analysis.

Results: The developed CPG included an ED management flowchart, an order set, risk stratification using the Glasgow-Blatchford Score (GBS), and a safe transfer checklist. Following its implementation, the CPG compliance score significantly rose from 10.4±2.3 to 17.6±1.5 (p < .001). There was an increase in the use of GBS, the administration of proton pump inhibitors (PPI) within 60 minutes, and the completion of the safe transfer checklist. Additionally, the time to make a referral decision significantly decreased, and adverse events during patient transfers were reduced. Healthcare personnel reported a high level of satisfaction with the guideline.

Conclusion: Utilizing an action research approach for the development of a CPG markedly enhanced the thoroughness of care processes, minimized treatment delays, and reduced adverse events during the transfer of patients with UGIB.