The power of a checklist: Decrease in emergency department epistaxis transfers after clinical care pathway implementation.
Am J Otolaryngol
; 42(4): 102941, 2021.
Article
em En
| MEDLINE
| ID: mdl-33592555
ABSTRACT
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Equipe de Assistência ao Paciente
/
Epistaxe
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Transferência de Pacientes
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Procedimentos Clínicos
/
Comunicação Interdisciplinar
/
Documentação
/
Serviço Hospitalar de Emergência
/
Centros de Atenção Terciária
/
Assistência ao Paciente
Tipo de estudo:
Etiology_studies
/
Guideline
/
Incidence_studies
/
Observational_studies
/
Risk_factors_studies
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article