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044 Stemming the flow
  1. Patrick Honour,
  2. Graeme McAlpine
  1. NHS Lothian


Standardising the practice of epistaxis care in an emergency department to improve patient outcomes.

Having a regional ENT centre on site we see a disproportionate number of epistaxis patients with over 500 cases a year.

All atraumatic haemodynamically stable epistaxis patients who had active ongoing bleeding in the department were included.

Developing a standard operating procedure based around the standard treatment arm of the NoPac study we focused on the step by step management of epistaxis to measure if this improves patient outcomes.

A tailored education package for the protocol was used in the department with posters, emails and information during handover to all staff in the department.

It follows a step by step method, starting with nasal pegs in triage, clot removal, cautery and adrenaline soaked rolls, depending on the persistence of the bleeding, eventually discharge or referral.

I Analysed TRAK data for all ‘Epistaxis’ diagnoses prospectively for 2 months pre and post intervention.

Any patient with a documented ‘active’ bleeding that was not haemodynamically unstable or a traumatic injury for the following outcomes;

Primary outcome was rate of Admission to ENT.

Secondary outcomes were, time in department and reattendance within 2 weeks.

A total of 34 patients were studied, 17 before and after the intervention.

Primary outcome of ENT admissions – Down from 41% to 11%.

Secondary outcomes of time in department - reduced by 39 minutes to 2h36 from 3h03.

And re-attendance rate remains the same at 24%

In conclusion we have seen a significant drop in ENT admissions alongside a decreased time in department without increasing re-attenders. Having a standardised plan for all epistaxis patients to receive early intervention with a clear protocol for the medical staff has improved patient safety and outcomes. These projects further benefit our department by keeping up with active research projects.

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