Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
Increased endoscopy list capacity improved adherence to timing guidelines and reduced hospital stay for non-variceal upper gastrointestinal bleeding patients.
Dates: June 2025 - December 2025
Implementation sites: Sunshine Coast University Hospital
This project as presented as a Poster at CEQ Showcase 2026 (PDF 125KB).
Aim
To assess baseline adherence to recommended endoscopy timing and evaluate the effect of increased endoscopy capacity on time to endoscopy, hospital length of stay (LOS), and 30-day mortality.
Outcomes
Overall Adherence:
The proportion of patients undergoing endoscopy within 24 hours increased from 49.1% pre-intervention to 55.8% post-intervention (p=0.55).
Non-IHT Cohort:
- Adherence to the 24-hour target improved from 54.3% to 73.3% (p=0.10).
- Median time to endoscopy decreased from 24 hours (range 2-104) to 17 hours (range 2-46) (p=0.07).
- After exclusion of outliers, median LOS significantly decreased from 4 days (range 1-13) to 3 days (range 1-7) (p=0.03).
IHT Cohort:
- No improvement was observed in 24-hour adherence (27.3% vs 14.3%, p=0.62).
- Median time to endoscopy was 45 hours (range 7-89) pre-intervention vs 50 hours (range 5-70) post-intervention (p=0.78).
- Median LOS was 5 days (range 3-13) vs 6 days (range 2-14) (p=0.40).
Baseline severity was comparable between groups.
Background
Non-variceal upper gastrointestinal bleeding (UGIB) is a common and potentially life-threatening medical emergency. Endoscopy is the cornerstone of both diagnosis and therapeutic intervention in these patients. Performing timely endoscopy is critical for achieving haemostasis, stratifying risk, guiding clinical decision-making, and ultimately improving patient outcomes.
Current evidence and international guidelines, including those from the European Society of Gastrointestinal Endoscopy (ESGE), the American College of Gastroenterology (ACG), and the British Society of Gastroenterology (BSG), recommend that endoscopy be performed within 6 to 24 hours of presentation. Adhering to this timeframe is associated with reduced mortality, lower rebleeding rates, decreased need for repeat endoscopic intervention, and shorter hospital stays. Delays beyond 24 hours can result in ongoing bleeding, hemodynamic instability, increased transfusion requirements, and prolonged hospitalisation.1,2,3 The ESGE also highlights that early endoscopy enhances resource utilisation and allocation efficiency.3
In tertiary hospitals such as the Sunshine Coast University Hospital (SCUH), managing high volumes of patients with upper GI bleeding can be complex. Competing clinical priorities-such as elective procedures, emergent cases, and staffing limitations-create a dynamic and often unpredictable clinical environment. These operational pressures can challenge the ability to consistently meet guideline-recommended endoscopy timeframes, potentially impacting patient outcomes.
Expanding endoscopy list capacity for more inpatient procedures improved time to endoscopy and reduced hospital length of stay.
Methods
A retrospective cohort study was undertaken at Sunshine Coast Health Service. Outcomes during a four-month pre-intervention period (June-September 2025; n=57) were compared with those from a three-month post-intervention period (October-December 2025; n=43). Only patients with stable non-variceal UGIB who were ready for endoscopy were included. Unstable patients were excluded.
The intervention involved the addition of two procedure points per weekday on an endoscopy list (equivalent to one non-variceal UGIB case), totalling 10 additional points per week. Data collected included inter-hospital transfer (IHT) status, time to endoscopy, LOS, 30-day mortality, Glasgow-Blatchford Score (GBS), and American Society of Anaesthesiologists (ASA) score. Statistical analyses were performed using Fisher's Exact Test for nominal variables and the Mann-Whitney U test for ordinal variables, with p<0.05 considered statistically significant.
Discussion
The success of this project was largely due to the strong support from the Director of Gastroenterology, who approved increasing endoscopy capacity. This allowed us to perform more inpatient procedures efficiently and gave us greater flexibility in scheduling other cases. A team effort involving gastroenterologists, trainees, nursing staff, and administrators was crucial, helping to improve communication and streamline workflow adjustments.
The project showed that expanding endoscopy capacity can improve adherence to international guidelines for timely intervention in non-variceal upper gastrointestinal bleeding and can reduce the hospital stay for patients admitted locally. However, logistical challenges related to inter-hospital transfers limited the benefits for this cohort of patients, highlighting an area needing further focus.
Limitations of the project included a relatively short follow-up period and a small sample size, which might restrict how broadly the results can be applied. Also, since the study only included stable patients, the findings may not be relevant for more complex or unstable cases.
The strengths of this initiative include its targeted approach, clear measurable outcomes like timing and length of stay, and its practicality in real-world settings. On the other hand, we didn't fully account for external factors such as staffing levels or fluctuations in patient volume, which could influence results. There's a real opportunity to expand this model to other departments and hospitals within Queensland Health, especially where resource limitations hinder timely care.
Looking ahead, I believe longer-term follow-up would be useful to assess whether these improvements are sustainable and how they impact overall patient outcomes. A cost-benefit analysis could also help determine the broader implications, particularly if increasing capacity shortens outpatient waiting lists and optimises resource use.
This project has potential beyond our hospital and could be successful in other Queensland Health facilities facing similar challenges. The next step is to scale up the intervention, strengthen coordination between hospitals, and evaluate long-term results, including patient mortality, rebleeding rates, and satisfaction. Continuous quality improvement will be essential to sustain and build on these gains.
References
- Guo CG, et al. Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study. Gut. 2022;71:1544-1550.
- Laine L, et al. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021;116(5):899-917.
- Gralnek IM, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): ESGE Guideline Update 2021. Endoscopy. 2021;53(3):300-332.
Key contact
Laurence Vaitiekunas
Registrar Gastroenterology (Fellow)
Sunshine Coast University Hospital