81 Audit of Use of Oakland Score on Patients Presenting with PR Bleeding and Effect on Admissions with Retrospective Application

Aim

To audit use of the validated Oakland Score for safe discharge of patients presenting to ED with PR bleeding and assess the effect of the Score on patient admissions.

Method

Retrospective audit of patients presenting to ED with PR bleeding between 1 Jan 22 - 30 Jun 22. Notes were reviewed and Oakland Score calculated. Threshold discharge scores of 8 and 10 were used to determine the effect on admission numbers. 88 patient notes were reviewed, 75 were included.

Results

0/72 patients had an Oakland Score on initial clerking. Retrospective application of the Oakland Score with a threshold of 8 would have increased admissions by 20/37 (54%). An admission threshold of 10 would have increased admissions by 3/37 (8.1%).

A threshold score of 8 suggests 27/37 patients were inappropriately discharged (73%) and 7/38 (18%) could have been safely discharged rather than admitted. 41/75 (55%) were admitted or discharged correctly.

A threshold score of 10 suggests 18/37 patients (47%) were inappropriately discharged and that 15/38 (39%) could have been safely discharged rather than admitted. 42/75 (56%) were admitted or discharged correctly.

Conclusions

PR bleeding represents a significant number of patients presenting acutely to general surgery. Discharge and admission of patients presenting with PR bleeding is inconsistent and subjective. Introduction of the Oakland Score would provide objective criteria for safe discharge and appropriate admission. An admission threshold of 10 has a 91% confidence in safe discharge and would not result in a large increase in admissions of otherwise healthy patients.