Improving efficiency in epistaxis transfers in a large health system: Analyzing emergency department treatment variability as pretext for a clinical care pathway
| Autor: | Nicole Maronian, Clare Richardson, Brian D'Anza, Chelsea S. Hamill, Anish Abrol, Kenneth Rodriguez |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Patient Transfer Facial trauma Emergency Medical Services medicine.medical_specialty Cautery Nasal Surgical Procedures Hospital Departments Psychological intervention Otolaryngology 03 medical and health sciences Patient safety 0302 clinical medicine Health care medicine Humans Tampons Surgical Clinical care 030223 otorhinolaryngology Retrospective Studies business.industry Emergency department Nosebleed medicine.disease Quality Improvement Epistaxis Otorhinolaryngology 030220 oncology & carcinogenesis Emergency medicine Critical Pathways Female Patient Safety medicine.symptom Emergency Service Hospital business |
| Zdroj: | American Journal of Otolaryngology. 40:530-535 |
| ISSN: | 0196-0709 |
| Popis: | Introduction Epistaxis is a common condition with an estimated $100 million in health care costs annually. A significant portion of this stems from Emergency Department (ED) management and hospital transfers. Currently there is no data in the literature clearly depicting the differences in treatment of epistaxis between Emergency Medicine (EM) physicians and Otolaryngologists. Clinical care pathways (CCP) are a way to standardize care and increase efficiency. Our goal was to evaluate the variability in epistaxis management between EM and Otolaryngology physicians in order to determine the potential impact of a system wide clinical care pathway. Materials and methods A retrospective case study was conducted of all patients transferred between emergency departments for epistaxis over an 18-month period. Exclusion criteria comprised patients under 18 years old, recent sinonasal surgery, bleeding disorders, and recent facial trauma. Results 73 patients met inclusion criteria. EM physicians used nasal cautery in 8%, absorbable packing in 1% and non-absorbable packing in 92% (with 33% being bilateral). In comparison, Otolaryngologists used nasal cautery in 37%, absorbable packing in 34%, and non-absorbable packing in 23%. Eighty percent of patients treated by an Otolaryngology physician required less invasive intervention than previously performed by EM physicians prior to transfer. Conclusions Epistaxis management varied significantly between Emergency Medicine and Otolaryngology physicians. Numerous patients were treated immediately with non-absorbable packing. On post-transfer Otolaryngology evaluation, many of these patients required less invasive interventions. This study highlights the variability of epistaxis treatment within our hospital system and warrants the need for a standardized care pathway. |
| Databáze: | OpenAIRE |
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