When should I consider urgent referral to secondary care for a patient with upper gastrointestinal bleeding?

Consider an urgent referral to secondary care for a patient presenting with upper gastrointestinal bleeding if they are haemodynamically unstable or have severe acute bleeding. Immediate endoscopy should be offered after resuscitation in such cases.

For all other patients with upper gastrointestinal bleeding, endoscopy should be offered within 24 hours of admission.

Use formal risk assessment scores such as the Blatchford score at first assessment to help identify patients who may require urgent intervention; a Blatchford score of 0 may indicate suitability for early discharge.

Patients with massive bleeding require transfusion of blood, platelets, and clotting factors according to local protocols, and those actively bleeding with coagulopathy or thrombocytopenia may need specific blood products.

Stop non-steroidal anti-inflammatory drugs during the acute phase and discuss antiplatelet therapy continuation with specialists.