Admission Prevention Intervention. New interdepartmental epistaxis pathway for community treatment at a UK teaching hospital
Philipp Schorscher, Liu A, Crossley E and Desai K
Brighton and Sussex Medical School, Germany
: J Otol Rhinol
Abstract
Background: A predicted 60% of any population experience a nosebleed at some point in their lifetime making Epistaxis the most common ENT emergency. Despite this, variation in management across UK emergency departments remains. New change-management theories in healthcare acknowledge the importance of identifying stakeholders and utilising grass roots approach to change. Aims: We developed an acute ENT emergency pathway which identified potential discharge patients for 24hour outpatient review post nasal packing. Medical students were recruited for a “fresh eyes” approach, and stakeholders from different departments were involved to coordinate implementation. Methods: A retrospective study of A&E epistaxis patients between Jan 2014-Jan 2015 (N=365, mean age 55yrs) was performed. Using formal reflective methodology we identified areas for improvement and suggestions for other organisations to consider when instigating similar pathway changes. Results: 29.0% (n=106) of patients were admitted (mean length of stay 2.8 days). Of these, 26.4% (n=28) were eligible for discharge under the new pathway, saving 78.4 bed days. No patients eligible for discharge experienced rebleeding or readmittance. Implementation was dependent on modality of communication, establishment of interdepartmental meetings, staff development programmes, effective communication environment and accurate and constant reporting. Whilst time consuming, continuous reinforcement and flow was indispensable for success. Conclusions: Inter-departmental collaboration has enabled an organisation-wide introduction and review of a new epistaxis pathway. This pathway is a safe and potentially effective way to improve our ENT service. We believe an awareness of the challenges we faced and the solutions developed will be of be nefit to other organisations interested in amending their practice towards recent epistaxis guidelines..
Biography
Philipp Schorscher has completed his International Baccalaureate at the United World College of Southern Africa, Swaziland. Having developed an interest in medicine after setting up a medical emergency education program he moved to the UK to further his knowledge at the Brighton and Sussex Medical School. Currently in year 3 of his studies, Philipp Schorscher is an active member of a variety of committees and current president of the University’s MSF society. His interest in Management led him to join the Imperial College Medical Management intercalation program for the upcoming academic year. .
E-mail: p.Schorscher1@uni.bsms.ac.uk
