[The benefits of centralization of care for patients with acute upper gastrointestinal bleeding]. / Prínos centralizace péce o pacienty s akutním krvácením do horního trávicího traktu.

ABSTRACT

INTRODUCTION: Acute upper gastrointestinal bleeding still remains one of the serious conditions that require a rapid diagnostic and therapeutic intervention. Such procedure is highly dependent on good interdisciplinary cooperation, which, when centralized, may positively influence mortality and economic costs. OBJECTIVE: To determine the benefits of centralization of care provided to patients with acute bleeding in the upper gastrointestinal tract. PATIENTS AND METHODS: A total of 632 patients with acute bleeding were enrolled in the study at two different health-care establishments of the same type, however with a different organisation of care. We have evaluated the influence of the organisation of care on the length of hospitalization stay, mortality and economic costs. RESULTS: Centralized treatment significantly shortens the interval from hospital admission to endoscopic examination and leads to a reduction in mortality, although not statistically significant. On the other hand, it does not affect the length of hospitalization, the distribution of patients between internal and surgical departments, and provides no guarantee of lower economic costs. Many other factors play an important role in that respect. It seems, that the importance of centralization plays the main role especially in the pre-hospital and early hospital period, when it accelerates and simplifies the diagnostic and therapeutic procedure.