Endoscopy Timing in Older Adults (≥75 Years) with Upper Gastrointestinal Bleeding Undergoing Esophagogastroduodenoscopy: A Retrospective Cohort Study

Key Takeaways for GI Nurses

• Current international guidelines recommending endoscopy within 24 hours for UGIB may not reflect actual practice patterns, particularly in older adult populations who comprise a significant portion of our patient load
• Real-world endoscopy timing in patients ≥75 years with UGIB requires closer examination, as this population may face unique challenges including comorbidities, medication management, and care coordination delays
• Understanding timing patterns in older adults can help endoscopy units optimize scheduling protocols and resource allocation for this vulnerable patient population
• This research highlights the need for age-specific considerations when implementing evidence-based timing protocols for urgent endoscopic procedures

Clinical Relevance

This study addresses a critical gap between guideline recommendations and real-world practice that directly impacts endoscopy nursing workflow and patient outcomes. As the population ages, endoscopy units are seeing increasing numbers of patients ≥75 years presenting with UGIB, yet these patients often present complex care coordination challenges that may affect adherence to the 24-hour endoscopy timeline. Factors such as anticoagulation management, cardiology clearance, family decision-making, and comorbidity stabilization can all contribute to procedural delays that may not be reflected in current guidelines.

For endoscopy nurses, understanding these timing patterns is essential for several operational aspects of care. Patient assessment and triage protocols may need age-specific modifications to account for the unique presentation and risk factors in older adults. Additionally, this research can inform staffing models and on-call scheduling, particularly if older patients require different timing considerations or more intensive pre-procedural preparation. The findings may also impact patient and family education, helping nurses set appropriate expectations about procedural timing while advocating for optimal care delivery.

From a quality improvement perspective, this study provides valuable data for developing age-stratified performance metrics and care pathways. Endoscopy units may need to reconsider their current quality indicators and develop more nuanced approaches to measuring appropriate care delivery in older adult populations, balancing the urgency of intervention with the complexity of care coordination required in this demographic.

Bottom Line

This retrospective cohort study examining endoscopy timing in older adults with UGIB reveals important discrepancies between guideline recommendations and real-world practice patterns, suggesting that endoscopy nurses and units need to develop age-specific protocols and performance metrics that account for the unique care coordination challenges and clinical complexity inherent in managing UGIB in patients ≥75 years old.