Outpatient management of epistaxis during COVID-19 to reduce inpatient
stay: a quality improvement project
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.