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Outpatient management of epistaxis during COVID-19 to reduce inpatient stay: a quality improvement project
  • Kaso Ari,
  • Rachael Collins
Kaso Ari
Norfolk and Norwich University Hospital
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Rachael Collins
Norfolk and Norwich University Hospital
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Abstract

Introduction: In March 2020, new guidelines allowed patients with epistaxis to be discharged home with nasal packs in situ to reduce the risk of inpatient covid transmission rates. Our objective is to review how successful these new guidelines have been and whether they could be safely maintained in future practice. Methods: This was a retrospective data analysis at a local tertiary ENT referral hospital. The study group consisted of patients admitted with epistaxis over one year. The “Pack and Home” criteria pathway was implemented. We reviewed the pathway 6 months pre and 6 months post pathway introduction. Primary outcome measure included compliance with the “Pack and Home” criteria and length of inpatient admissions. Results: A total of 131 patients required nasal packing, with 72 patients (55%) in loop 1 and 59 patients (45%) in loop 2. In the first loop all 72 patients (100%) were admitted for inpatient care. However, in the second loop 21 patients (36%) were discharged home with nasal pack in situ and 59 patients (64%) were admitted. Of those discharged, 2 patients re-presented after 48 hours with re-bleeding. The average total length of inpatient stay in loop 1 was significantly higher at 45.7 hours and 29.6 hours in loop 2 (p<0.05). All discharged patients attended their outpatient appointment in under 3 days. Conclusion The “Pack and Home” criteria can successfully identify patients who are suited for an outpatient management pathway. This could reduce surgical inpatient load and the way we manage epistaxis.