Murat Jakanov

Background: Gastrointestinal bleeding (GIB), particularly upper gastrointestinal bleeding (UGIB), requires rapid coordination between emergency medical services (EMS) and hospital teams, yet evidence on how service organization affects timeliness and practice is limited in Kazakhstan. Aim: To evaluate the organization of GIB care in Almaty region, with emphasis on clinician knowledge and practice, EMS performance, and organizational features of hospital care. Methods: We conducted a cross-sectional survey between March and October 2024 involving two broad respondent groups and three distinct samples: a hospital-based group comprising 99 inpatient clinicians and 99 hospital representatives, and an EMS group comprising 120 personnel. The three samples completed different questionnaires and were analyzed separately. Descriptive analyses, chi-square or Fisher's exact tests, and exploratory Spearman correlations were used. Results: Inpatient clinicians showed near-universal agreement with guideline-based UGIB management principles, but self-reported adherence was inconsistent. Only 1.0% reported always using validated risk scores, and 99.0% reported only sometimes protecting the airway before endoscopy in patients with active hematemesis and altered mental status. In unadjusted respondent-level analyses, clinicians with ≥5 years of experience more frequently reported adequate training and perceived risk scores as useful (both p < 0.001). In the EMS group, all six respondents reporting arrival within 10 min were in the ≥16-team category (6/58, 10.3%; Fisher's exact p = 0.047). Reported ambulance-team availability showed a modest inverse correlation with continuous arrival time ( ρ =−0.277, p = 0.002), while completion of selected examinations and vital-sign assessments differed across team-availability categories (all p < 0.001). All hospital representatives reported 24-hour endoscopist availability, but important elements of written protocol content were reported less consistently. Conclusions: UGIB care in the Almaty region showed consistently described structural endoscopy availability but incomplete protocol content, together with selected inpatient-practice and prehospital differences. The EMS findings were exploratory and require confirmation using operational and patient-level data.

Background: Acute gastrointestinal bleeding is common, yet evidence on how best to organize hospital services for these emergencies is limited. To synthesize evidence on organizational models for delivery of care to adults with acute gastrointestinal bleeding. Methods: We systematically searched four databases (2015–2025) for studies evaluating organizational interventions in hospitalized adults with upper or lower gastrointestinal bleeding. Eligible models included hub and spoke networks, multidisciplinary team (MDT) programs, structured care bundles and transfusion free pathways. Two reviewers screened records, extracted data and assessed risk of bias using ROBINS-I. Owing to heterogeneity of interventions and outcomes; we undertook narrative synthesis. Primary outcomes were mortality, rebleeding, readmission, length of stay and process measures. Results: Of 978 records identified, three studies met the inclusion criteria. One large cohort compared hub and spoke network hospitals with non network hospitals and found no difference in risk adjusted mortality, although gastroenterology wards and academic centers were associated with better survival. A single center MDT programmed for cirrhotic variceal bleeding reported lower mortality, reduced rebleeding, fewer readmissions and shorter stay. A bloodless medicine cohort showed that transfusion free management achieved low mortality despite very low nadir hemoglobin. Reporting of quality of life and other patient reported outcomes was very rare. All studies were at serious risk of bias, with limited generalizability and no economic evaluation. Conclusion: Evidence on organizational models for acute gastrointestinal bleeding is sparse but suggests potential benefits of multidisciplinary and bloodless care programs, while network affiliation alone may be insufficient to improve outcomes.