Does epistaxis outcomes change with level of training?

Retrospective Study, Departmental Audit

Aims:

Does interdepartmental junior doctors’ cross-cover in ENT provide value for money service to patients?

Methods:

A retrospective analysis of epistaxis patients admitted to a district general hospital.  The trainees (ENT & Orthopaedics junior trainees) had at their disposal the commonly used materials for epistaxis management. Looking at outcomes when patients were treated by ENT trainees versus non ENT trainees

Results:

62 patients (31 males, 31 females) were admitted to hospital over the study period.
The mean age for males and females were 55 years and 66 years respectively. On admission, non-ENT trainees documented 58% of patients were actively bleeding, compared to 88% in a previous departmental clinical audit findings when ENT trainees treated the patients. 28% of patients had high blood pressure compared to 67% in the previous clinical audit when cover was by ENT trainees, 15% had head injury (5% in the previous audit), The use of the posterior nasal balloon packs had decreased from 11% when ENT trainees treated the patients to 5% when non ENT trainees treated the patients. The average hospital stay was 2.6 days compared to 1.5 days when ENT trainees treated patients.

Conclusions:

When non-ENT trainees covered the night on call, they unnecessarily packed and admitted patients over night to hospital. Extra training and education would be required if the hospital management team asks for non-ENT trainees to cover ENT emergency epistaxis patients.