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The power of a checklist: Decrease in emergency department epistaxis transfers after clinical care pathway

Clare Richardson1, Anish Abrol1, Claudia I Cabrera1

  • 1Department of Otolaryngology - Head and Neck Surgery, University Hospitals Cleveland Medical Center - Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, United States of America.

American Journal of Otolaryngology
|February 16, 2021
PubMed
Summary
This summary is machine-generated.

Implementing a clinical care pathway (CCP) for epistaxis in the emergency department (ED) significantly reduced patient transfers by 61%. This standardized treatment improved care and decreased unnecessary hospitalizations.

Keywords:
Clinical care pathwayEpistaxisHospital transfersQuality improvementStandard of care

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Area of Science:

  • Emergency Medicine
  • Clinical Pathway Development
  • Healthcare Improvement

Background:

  • Epistaxis (nosebleeds) incurs significant costs for US hospitals, exceeding $100 million annually.
  • Variable treatment protocols in emergency departments (EDs) present an opportunity for care standardization and improvement.

Purpose of the Study:

  • To implement and evaluate an epistaxis clinical care pathway (CCP) within an emergency department (ED) setting.
  • To assess the impact of the CCP on treatment practices and patient transfer rates.

Main Methods:

  • A multidisciplinary team developed and implemented an epistaxis CCP across a tertiary hospital system with 11 EDs.
  • A retrospective analysis compared eight-month periods before and after CCP implementation, including 309 pre-implementation and 322 post-implementation patients diagnosed with epistaxis (excluding minors, recent surgery/trauma, or bleeding disorders).

Main Results:

  • CCP implementation led to a 61% reduction in patient transfers (p < 0.001).
  • Significant increases were observed in ED provider documentation of anterior rhinoscopy (51%), use of topical vasoconstrictors (34%), and absorbable packing (40%).
  • A decrease in non-absorbable packing use was noted, with unilateral packing down 7% and bilateral down 17%.

Conclusions:

  • ED treatment for epistaxis was highly variable prior to CCP implementation.
  • The CCP effectively standardized treatment protocols and significantly reduced hospital transfers.
  • A CCP checklist serves as an effective tool for standardizing epistaxis care and preventing unnecessary transfers.