TY - JOUR T1 - 044 Stemming the flow JF - Emergency Medicine Journal JO - Emerg Med J SP - 805 LP - 805 DO - 10.1136/emermed-2019-RCEM.44 VL - 36 IS - 12 AU - Patrick Honour AU - Graeme McAlpine Y1 - 2019/12/01 UR - http://emj.bmj.com/content/36/12/805.2.abstract N2 - 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.Abstract 044 Figure 1 ER -