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A New Hybrid Quantitative Evaluation Model for Axillary Junctional Hemorrhage in Swine
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Epistaxis management at Guy's Hospital, 2009-2011: full audit cycles.

A C Hall1, M Simons1, G Pilgrim1

  • 1Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK.

The Journal of Laryngology and Otology
|December 3, 2013
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Summary

This study evaluated epistaxis management against best practices. Implementing an algorithm improved patient care and nasal examination rates in the emergency department.

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Area of Science:

  • Otolaryngology
  • Emergency Medicine
  • Healthcare Quality Improvement

Background:

  • Epistaxis (nosebleeds) management requires adherence to best practice standards.
  • Tertiary referral hospitals play a crucial role in managing complex cases.
  • Previous management protocols may not have been consistently applied.

Purpose of the Study:

  • To evaluate the current management of epistaxis at a tertiary ENT referral hospital.
  • To compare existing practices against a recently published standard of best practice.
  • To assess the impact of implementing a new management algorithm.

Main Methods:

  • Retrospective review of 50 consecutive inpatient epistaxis cases in 2009.
  • Implementation of an epistaxis best practice algorithm and education sessions.
  • Repeat retrospective reviews of 50 patients in 2010 and 2011 to assess changes.

Main Results:

  • Initial audit showed only 8% of patients had adequate nasal examination in the ED.
  • Nasal cautery was not documented in any initial cases.
  • Surgical interventions were performed on only 40% of eligible patients.
  • Subsequent audits demonstrated progressive improvement in evaluation and management post-algorithm implementation.

Conclusions:

  • The introduction of a standardized epistaxis algorithm significantly improved initial patient evaluation and management.
  • Sphenopalatine artery ligation is an effective option for refractory epistaxis.
  • Continuous auditing is essential for maintaining and improving clinical practice standards.