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].