When faced with the same facts, physicians often make different decisions.
Dr Esrailian and colleagues from California, USA performed a survey to measure the process of care and variations in decision-making in nonvariceal upper gastrointestinal (GI) tract hemorrhage.
The research team compared results between experts and non-experts.
The team administered a vignette survey to elicit knowledge and beliefs about nonvariceal upper gastrointestinal tract hemorrhage, including 13 'best practice' guidelines.
The researchers reported that 188 gastroenterologists responded.
Experts endorsed more 'best practices' than non-experts.
Non-experts were more likely to endorse incorrectly bolus dosing vs continuous infusion of intravenous proton pump inhibitors.
The team noted that non-experts were more likely to select standard-channel vs large-channel endoscopes in high-risk bleeding.
|Experts are more likely to comply with hemorrhage guidelines|
|Alimentary Pharmacology & Therapeutics |
There were wide variations within groups regarding the timing of nasogastric lavage, use of promotility agents, use of hemoclips, and appropriateness of snaring clots overlying ulcers.
Dr Esrailian’s team concluded, “Experts are more likely to comply with nonvariceal upper gastrointestinal tract hemorrhage guidelines.”
“Non-experts diverge from experts in the dosing of proton pump inhibitors, and choice of endoscope in high-risk bleeding.”
“Moreover, there are wide variations in key practices even within groups.”
“This suggests that best practices have been generally well disseminated, but that persistent disconnects exist that should be further investigated.”