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

Richardson, Clare; Abrol, Anish; Cabrera, Claudia I.; Goldstein, Jessica R.; Maronian, Nicole; Rodriguez, Kenneth; D’Anza, Brian

doi:10.1016/j.amjoto.2021.102941

Cited by 4 publications

(15 citation statements)

References 30 publications

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“…Cauterization and nasal packing are a key interventional step in numerous clinical care pathways (CCP) published in both the International Journal of Otolaryngology and American Journal of Otolaryngology . 10 , 11 Richardson et al wrote a specific checklist in 2021 to provide ED clinicians with a clinical care pathway to aid in reducing the amount of inconsistencies between EM and Otolaryngology treatment, the clinical care pathway led to a 61% decrease of transfer for epistaxis and a reduction of healthcare cost. 10 Cauterization as a treatment option is more viable if the source of bleeding can be identified, and provides economic advantages compared to the cost of nasal packing.…”

Section: Resultsmentioning

confidence: 99%

“… 10 , 11 Richardson et al wrote a specific checklist in 2021 to provide ED clinicians with a clinical care pathway to aid in reducing the amount of inconsistencies between EM and Otolaryngology treatment, the clinical care pathway led to a 61% decrease of transfer for epistaxis and a reduction of healthcare cost. 10 Cauterization as a treatment option is more viable if the source of bleeding can be identified, and provides economic advantages compared to the cost of nasal packing. 2 , 10 , 11 Cauterization should be used if the location of the bleed can be identified in cases of anterior epistaxis.…”

Section: Resultsmentioning

confidence: 99%

“… 10 Cauterization as a treatment option is more viable if the source of bleeding can be identified, and provides economic advantages compared to the cost of nasal packing. 2 , 10 , 11 Cauterization should be used if the location of the bleed can be identified in cases of anterior epistaxis. 12 If the bleeding site is not identified or cauterization is not available, nasal packing is required, which leads to them being closely related in the clinical care pathway.…”

Section: Resultsmentioning

confidence: 99%

“… 3 Absorbable packing should be attempted before non-absorbable packing due to patient comfort; absorbable packing materials include surgicel, thrombin-soaked gelfoam, and floseal. 10 Absorbable packing can be used in both anterior and posterior epistaxis, though it is more typically involved in anterior epistaxis. 2 …”

Section: Resultsmentioning

confidence: 99%

“…All patients with posterior packing should be seen by an ENT specialist when one becomes available or be transferred to an institution that has ENT specialty. 4 , 10 Anterior nasal packing is used when digital compression fails to stop the bleeding, and when identification of the source of the bleed cannot be identified or cautery fails to stop the bleeding. 3 , 10 , 11 …”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Nasal Packing in the Emergency Department: A Practical Review for Emergency Providers

Tran¹,

Barnett²,

O’Connell³

et al. 2021

OAEM

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We performed a narrative review of epistaxis management in the emergency department. First, we examined the pathophysiology, the current types of treatment that are available to emergency clinicians. When nasal packing is indicated, we examined the efficacy of nasal packing in addition to other topical treatment such as tranexamic acid and the evidence of prophylactic antibiotics. We detailed current studies involving tranexamic acid and prophylactic antibiotics for nasal packing. Finally, we introduced an epistaxis clinical care pathway, based on current evidence, to aid emergency clinicians with their clinical decision-making processes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Nasal Packing in the Emergency Department: A Practical Review for Emergency Providers

Tran¹,

Barnett²,

O’Connell³

et al. 2021

OAEM

Self Cite

View full text Add to dashboard Cite

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Emergency department visits following endoscopic skull base surgery: An opportunity for improvement

Godse

Jarmula

Kshettry

et al. 2023

Int Forum Allergy Rhinol

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BackgroundReadmissions are major healthcare expenditures, key hospital metrics, and are often preceded by an evaluation in the emergency department (ED). The purpose of this study was to analyze ED visits within 30 days of endoscopic skull base surgery (ESBS), risk factors for readmission once in the ED, and ED‐related evaluation and outcomes.MethodsRetrospective review from January 2017 to December 2022 at a high‐volume center of all ESBS patients who presented to the ED within 30 days of surgery.ResultsOf 593 ESBS cases, 104 patients (17.5%) presented to the ED following surgery within 30 days, with a median presentation of 6 days post‐discharge (IQR 5–14); 54 (51.9%) patients were discharged while 50 (48.1%) were readmitted. Readmitted patients were significantly older than discharged patients (median 60 years, IQR 50–68 vs. 48 years, 33–56; p < 0.01). Extent of ESBS was not associated with readmission or discharge from the ED. The most common discharge diagnoses were headache (n = 13, 24.1%) and epistaxis (n = 10, 18.5%); the most common readmitting diagnoses were serum abnormality (n = 15, 30.0%) and altered mental status (n = 5, 10.0%). Readmitted patients underwent significantly more laboratory testing than discharged patients (median 6, IQR 3–9 vs. 4, 1–6; p < 0.01).ConclusionsApproximately half of patients who presented to the ED following ESBS were discharged home but underwent significant workup. Follow‐up within 7 days of discharge, risk‐stratified endocrine care pathways, and efforts to address the social determinants of health may be considered to optimize postoperative ESBS care.

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Epistaxis Treatment Options: Literature Review

Mylonas

Nikolaidis

Hajiioannou

2023

Indian J Otolaryngol Head Neck Surg

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

Cited by 4 publications

References 30 publications

Nasal Packing in the Emergency Department: A Practical Review for Emergency Providers

Nasal Packing in the Emergency Department: A Practical Review for Emergency Providers

Emergency department visits following endoscopic skull base surgery: An opportunity for improvement

Epistaxis Treatment Options: Literature Review

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