Enhancing Patient Transfer for Acute Upper Gastrointestinal Bleeding through ISBAR and Joint Standard Operating Protocols between the Emergency Department and Endoscopy Unit

Abstract

Upper gastrointestinal bleeding (UGIB) is a time-critical medical emergency requiring continuous and coordinated care from the Emergency Department (ED) to the Endoscopy Unit. This article synthesizes the system-based nursing roles that enhance patient safety and clinical outcomes throughout this continuum. The nursing process begins with structured assessment and resuscitation following the ABCDE principles, implementation of a restrictive transfusion strategy (initiating transfusion when hemoglobin is < 7 g/dL, unless specific indications exist), and administration of high-dose intravenous proton pump inhibitors (PPIs) before and after endoscopy to maintain gastric pH above 6 and reduce the risk of rebleeding. Emergency nurses play a central role in coordinating the transfer from ED to endoscopy using structured ISBAR communication and continuous vital-sign monitoring during intrahospital transport. Upon arrival at the endoscopy unit, Endoscopy nurses prioritize airway safety, monitor procedural sedation according to SGNA Standards, recording vital signs every 3–5 minutes, and support endoscopic hemostasis through injection therapy, thermal Therapy, and mechanical methods. Post-procedurally, nurses focus on safe recovery by maintaining a left lateral position, closely monitoring vital signs for the first hour, detecting signs of rebleeding, and providing discharge Education on the avoidance of NSAIDs and alcohol, adherence to ongoing PPI therapy, and scheduled follow-up. At the systems level, establishing a joint ER–Endoscopy standard operating protocol (SOP) with a target endoscopy time of 12–24 hours, forming a Rapid Endoscopy Response Team, and integrating Early Warning Scores or AI-based triage can reduce door-to-endoscopy time, mortality, and rebleeding rates while improving overall service quality.