The following is a summary of “Implementation of a Bleeding Risk Screening Tool and Hematology Referral Process Prior to Pediatric Endoscopy,” published in the November 2023 issue of Pediatrics by McSorley, et al.

For a study, researchers sought to address the potential variation in bleeding risk among patients undergoing gastrointestinal (GI) endoscopic procedures despite the generally low overall bleeding risk of 0.11%. The objective was to implement and assess the effectiveness of an abbreviated history-based bleeding risk screening tool and a hematology referral process to identify individuals at a higher risk of bleeding before their initial endoscopy.

The gastroenterology and hematology divisions at Children’s Wisconsin adopted a validated, history-based bleeding risk screening tool. They established a hematology referral process to identify patients at risk for bleeding before their first endoscopy. The study evaluated provider compliance with the bleeding risk screening, the effectiveness of referrals to hematology, time taken for patients to be seen in the hematology clinic, incidence of new bleeding disorder diagnoses, and occurrences of bleeding complications. The assessment covered a period from 2019 to 2021, divided into three phases.

Throughout the study, provider compliance with the bleeding risk screening improved from 48% (120/251) to 75% (189/253). Among those screening positive, compliance with referral to hematology ranged from 38% to 74% across the study phases. The overall time for patients to be seen by hematology decreased from 30 days to 7.5 days. Of the patients who screened positive and were seen in the hematology clinic, 22% (4/18) received a new diagnosis of a bleeding disorder. Notably, no bleeding complications were observed in the study population.

The quality improvement initiative successfully introduced a standardized bleeding risk screening tool, emphasizing the importance of a history-based approach. The modified screening tool identified individuals with previously undiagnosed bleeding disorders, and proactive measures were implemented to prevent procedural bleeding complications.

Source: journals.lww.com/jpgn/abstract/2023/11000/implementation_of_a_bleeding_risk_screening_tool.17.aspx