A change in UK epistaxis management

Ear nose and throat oral and maxillofacial surgery service provision is undergoing major changes within the United Kingdom Healthcare System (NHS) with devolution of many treatments to primary care. Epistaxis, active bleeding from the nose, is a common ear nose and throat/oral and maxillofacial surgery emergency, and can be severe or even fatal. The causes can be from local or systemic illnesses. We aimed to apply a revised clinical protocol to epistaxis patients presenting to an Accident and Emergency (A&E) department of a District General Hospital (DGH) and to compare the results to the routine management protocol in same hospital. Sixty consecutive patients suffering epistaxis of local origin in an Accident and Emergency department in a District General Hospital were included in this study which was conducted over a 7-month-period (September-March). A revised management protocol was developed using nasal tampons (Netcel Polyvinyl alcohol sponge) and a proforma was created for the A&E department. Retrospective recorded data of all cases who presented with epistaxis of local origin to the A&E department in the same DGH in the past 4 years, (September-March), were analysed. Data collected included: patient's demographics, cause of epistaxis, management plan, admission, in-patient stay and complications. Previously, all patients requiring nasal packing were admitted. Over the previous 4-year-period (September-March) a mean of 28 patients were admitted per month, with a mean duration of in-patient stay of 2.7 days. In the patients' group treated under the revised protocol, the total number of admissions was significantly reduced, by 73%, (P < 0.0001), despite no significant change in the number of monthly epistaxis referrals (P < 0.0001). There was also a significant increase in the mean age of admitted patients with epistaxis (P < 0.0001), the admitted patients had a mean length of stay of 2.5 days. This revised management protocol saved 201 bed days per annum. After careful assessment and provided that nasal packing properly performed and advice sheet is given and understood, we believe it is safe to manage patients with routine epistaxis at home. This is a change to the current standard UK management. We discuss the case for and against the adoption of this policy by the main healthcare components (primary and secondary) of the NHS. We present an economic argument.