This approach of using formal, pre-endoscopic risk assessment systems and the requirement for careful communication of clinical condition in order to plan endoscopie intervention lends itself to the development of a combined standardised protocol for management and referral in AUGIB. Although the use of guidelines has historically given rise to a fear of "cookbook medicine"", guidelines have been shown to improve the quality of patient care, as well as having the potential to reduce the number of errors and malpractice litigation. For these reasons a pro-forma was developed at our institution which incorporated a preendoscopic risk assessment tool and key elements of the AUGIB protocol [see appendix 1].