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

Autor: Richardson C; Department 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., Abrol A; Department 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., Cabrera CI; Department 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., Goldstein J; Department of Emergency Medicine, University Hospitals Cleveland Medical Center - Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, United States of America., Maronian N; Department 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., Rodriguez K; Department 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., D'Anza B; Department 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. Electronic address: brian.d'anza@uhhospitals.org.
Jazyk: angličtina
Zdroj: American journal of otolaryngology [Am J Otolaryngol] 2021 Jul-Aug; Vol. 42 (4), pp. 102941. Date of Electronic Publication: 2021 Jan 29.
DOI: 10.1016/j.amjoto.2021.102941
Abstrakt: Background: Annually, epistaxis costs US hospitals over $100 million dollars. Many patients visit emergency departments (ED) with variable treatment, thus providing opportunity for improvement.
Objective: To implement an epistaxis clinical care pathway (CCP) in the ED, and analyze its effects on treatment and ED transfers.
Methods: An interdisciplinary team developed the CCP to be implemented at a tertiary hospital system with 11 satellite EDs. The analysis included matched eight-month periods prior to pathway implementation and after pathway implementation. Subjects included patients with ICD-10 code diagnosis of epistaxis. Patients under 18 years old, recent surgery or trauma, or bleeding disorders were excluded. There were 309 patients from the pre-implementation cohort, 53 of which were transferred and 37 met inclusion criteria; 322 from the post-implementation cohort, 37 of which were transferred, and 15 met inclusion criteria. Outcome measures included epistaxis intervention by ED providers and otolaryngologists before and after pathway implementation.
Results: CCP implementation resulted in a 61% reduction in patient transfers (p < 0.001). ED providers showed a 51% increase in documentation of anterior rhinoscopy with proper equipment, 34% increased use of topical vasoconstrictors, 40% increased use of absorbable packing, 7% decrease in use of unilateral non-absorbable packing, and 17% decrease in use of bilateral non-absorbable packing.
Conclusions: Prior to CCP implementation, ED treatment of epistaxis varied significantly. CCP resulted in standardized treatment and significant reduction in transfers. A CCP checklist is an effective way to standardize care and prevent unnecessary hospital transfers.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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