Abstract
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.