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Creating a Protocol for the Management of Epistaxis in a Tertiary Care Centre - A Practical Application of the British Rhinological Society Multidisciplinary Consensus Recommendations on the Hospital Management of Epistaxis

Matt Lechner, Oscar Emanuel, Deepak Chandrasekharan, Joshua Michaels, Gulwish Moghul, Nish Mehta, Jacklyn Liu, Claire Hopkins, Valerie J. Lund, Hassan El Hassan, Santdeep Paun, Nicholas Eynon-Lewis

Epistaxis is the most common acute presentation to ENT services in the UK. The recent British Rhinological Society multidisciplinary consensus recommendations provide new guidance for its management. To better align with these, we reviewed current practice in our tertiary referral centre. We noted practice variation both within and between departments, particularly concerning the timing and utilisation of nasal packing, accounting for inpatient stay [1]. The aim of this project was to reduce nasal packing for the initial management of epistaxis and increase attempted nasal cautery. We adapted the BRS guidelines for local use and worked with key stakeholders to establish a stepwise management algorithm for epistaxis, which would be suitable for all practitioners to initiate, regardless of specialty. This was discussed in an audit meeting with consultants, registrars, and junior doctors to assess clinical and practical acceptability. After refinement, we produced a step-by-step flowchart, which would serve as the local reference for management of epistaxis. After implementation, our prospective audit showed that inpatient admissions from epistaxis were reduced without adverse events or a significant increase in readmissions. Our QI process and protocol could be used as a safe way to disseminate and implement BRS guidelines at the local level.