Impact of Floseal and NasoPore in Managing Epistaxis in the Emergency Department: A Quality Improvement Analysis

Epistaxis is a common ear, nose, throat (ENT) presentation in the emergency department (ED), with the majority of the population having experienced an episode during their lifetime and required hospitalization. Like many district general hospitals (DGHs) in the country, St Peter's Hospital does not offer adult inpatient or out-of-hours emergency cover for ENT, necessitating patients who require intranasal packing with a Rapid Rhino® (Smith & Nephew, Hull, UK) to be transferred to another hospital for assessment and admission, with most transfers being via ambulance. Apart from being resource-heavy, both the procedure itself and the prolonged stay in ED awaiting transport are a distressing experience for the patient. Therefore, the present quality improvement analysis was performed for the assessment of the effectiveness of Floseal® (Baxter Healthcare, Deerfield, IL, USA) and NasoPore® (Stryker, Kalamazoo, MI, USA), a bioresorbable material for epistaxis.

We introduced the revised Royal College of Surgeons (RCS) ENT UK guidelines for epistaxis management in our department. Two Plan-Do-Study-Act (PDSA) cycles were conducted in parallel. To assess the patient experience, a feedback form was designed with particular focus on pain score using the Visual Analog Scale (VAS). IBM SPSS Statistics for Windows, Version 16 (Released 2007; IBM Corp., Armonk, New York, United States) was used for descriptive analysis, and cost-effectiveness analysis was also performed to compare the outcomes with rapid rhino nasal packing. A telephonic follow-up on days 2 and 5 was organized to document any adverse features.

The use of bioresorbable nasal packing among 60 patients demonstrated a clear benefit over the conventional practice of a non-absorbable packing, like Rapid Rhino. It reduced the length of stay (LOS) in ED and allowed the patients to go home with self-care instructions. In addition to much better patient comfort and tolerability (drop in pain score from 7 to 2 on VAS), this intervention also had a significant cost-saving impact with more than 65% cost reduction.

Floseal bioresorbable material can be used as a replacement for traditional nasal packing, as it was found to be more effective and cost-effective.