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

Urgent referral to secondary care for a patient with suspected upper gastrointestinal bleeding should be considered in the following situations:

• When the patient is unstable with severe acute upper gastrointestinal bleeding, offer endoscopy immediately after resuscitation.
• All other patients with upper gastrointestinal bleeding should have endoscopy within 24 hours of admission.
• Patients presenting with massive bleeding require transfusion with blood, platelets, and clotting factors according to local protocols.
• Patients who are actively bleeding and have a platelet count less than 50 x 10⁹/litre or abnormal coagulation parameters should receive appropriate blood products urgently.
• Stop non-steroidal anti-inflammatory drugs during the acute phase and discuss antiplatelet therapy continuation with specialists.

These criteria indicate the need for urgent secondary care assessment and management to stabilize the patient and perform timely endoscopy for diagnosis and treatment.

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