Objective:

To synthesize evidence on organizational models for delivery of care to adults with acute gastrointestinal bleeding.

Approach:

• Search Methodology: Systematic search of four databases for studies evaluating organizational interventions in hospitalized adults with upper or lower gastrointestinal bleeding from 2015 to 2025.
• Inclusion Criteria: Eligible models included hub and spoke networks, multidisciplinary team (MDT) programs, structured care bundles, and transfusion-free pathways.
• Data Extraction: Two reviewers screened records, extracted data, and assessed risk of bias using ROBINS-I.
• Synthesis Method: Narrative synthesis due to heterogeneity of interventions and outcomes.

Key Findings:

• Three studies met inclusion criteria from 978 records identified.
• 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 program for cirrhotic variceal bleeding reported lower mortality, reduced rebleeding, fewer readmissions, and shorter stays.
• A bloodless medicine cohort showed that transfusion-free management achieved low mortality despite very low nadir hemoglobin.
• Quality of life and other patient-reported outcomes were rarely reported.
• All studies were at serious risk of bias, with limited generalizability and no economic evaluation.

Interpretation:

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.

Limitations:

• Limited number of studies included in the review.
• High risk of bias in all studies.
• Lack of generalizability and economic evaluations.

Conclusion:

Evidence on organizational models for acute gastrointestinal bleeding is limited, indicating a need for further research.