Matt Lechner¹*, Oscar Emanuel¹, Deepak Chandrasekharan¹, Joshua Michaels¹, Gulwish Moghul¹, Nish Mehta², Jacklyn Liu², Claire Hopkins³, Valerie J Lund², Hassan El Hassan¹, Santdeep Paun¹ and Nicholas Eynon-Lewis¹

¹Department of Otolaryngology - Head and Neck Surgery, Royal London Hospital and Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
²Royal National Throat, Nose and Ear Hospital/Head and Neck Centre, University College London Hospitals NHS Foundation Trust, London, UK
³Guy’s Hospital, Guy’s and St. Thomas’ Hospitals NHS Foundation Trust, London, UK

*Corresponding Author: Matt Lechner, Department of Otolaryngology - Head and Neck Surgery, Royal London Hospital and Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.

Received: October 14, 2021; Published: December 09, 2021

Abstract

Epistaxis is the most common acute presentation to ENT services in the UK. The recent British Rhinological Society multidisciplinary consensus recommendations [1] provide new guidance for its management. To better align with these, we reviewed current practice in our tertiary referral centre. We noted practice variation both within and between departments, particularly concerning the timing and utilisation of nasal packing, accounting for inpatient stay. The aim of this project was to reduce nasal packing for the initial management of epistaxis and increase attempted nasal cautery. We adapted the BRS guidelines for local use and worked with key stakeholders to establish a stepwise management algorithm for epistaxis, which would be suitable for all practitioners to initiate, regardless of specialty. This was discussed in an audit meeting with consultants, registrars, and junior doctors to assess clinical and practical acceptability. After refinement, we produced a step-by-step flowchart, which would serve as the local reference for management of epistaxis. After implementation, our prospective audit showed that inpatient admissions from epistaxis were reduced without adverse events or a significant increase in readmissions. Our QI process and protocol could be used as a safe way to disseminate and implement BRS guidelines at the local level.

Keywords: Epistaxis; Nose Bleed; Cautery; Audit; Quality Improvement; Acute Care; British Rhinological Society Multidisciplinary Consensus Recommendations on the Hospital Management of Epistaxis

References

1. National ENT Trainee Research Network. “British Rhinological Society Multidisciplinary Consensus Recommendations on the Hospital Management of Epistaxis”. Journal of Laryngology and Otology12 (2017): 1142-1156.
2. Cummings CW., et al. Cummings Otolaryngology, Mosby Inc., (2004).
3. NICE, Costing Statement: Implementing The NICE Guideline On Transition Between Inpatient Hospital Settings And Community Or Care Home Settings For Adults With Social Care Needs (NG27). Putting NICE Guidance into Practice. NICE. (2015).
4. Fox R., et al. “Epistaxis management: current understanding amongst junior doctors”. Journal of Laryngology and Otology3 (2016): 252-255.
5. , et al. “Can trainees design and deliver a national audit of epistaxis management? A pilot of a secure web-based audit tool and research trainee collaboratives”. Journal of Laryngology and Otology 131.6 (2017): 518-522.

Citation

Citation: Matt Lechner., et al. “Creating a Protocol for the Management of Epistaxis in a Tertiary Care Centre - A Practical Application of the British Rhinological Society Multidisciplinary Consensus Recommendations on the Hospital Management of Epistaxis".Acta Scientific Otolaryngology 4.1 (2022): 03-06.

Copyright

Copyright: © 2022 Matt Lechner., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.