title: Epistaxis management at Guy's Hospital, 2009-2011: full audit cycles.
abstract: OBJECTIVE
  To assess management of epistaxis at a tertiary ENT referral hospital against a recently published standard of best practice.
  
  
  METHODS
  Fifty consecutive cases of acute epistaxis that required admission to Guy's Hospital in 2009 were evaluated. Epistaxis education sessions were held to introduce our algorithm of best practice in tandem with an emphasis on emergency department care. Similar retrospective reviews were carried out in both 2010 and 2011 (on groups of 50 patients).
  
  
  CONCLUSIONS
  The first audit cycle demonstrated that only 8 per cent of patients underwent a suitable nasal examination in the emergency department prior to transfer, with no documented attempts at nasal cautery. Surgical intervention procedures were performed on only 40 per cent of eligible patients. The audit cycles that followed the introduction of the epistaxis algorithm demonstrated continued improvement in initial evaluation and management of epistaxis. In select patients, sphenopalatine artery ligation can provide timely, definitive management of refractory epistaxis.
authors.affiliation: Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: A C
authors.initials: AC
authors.lastname: Hall
authors.affiliation: Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Simons
authors.affiliation: Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Pilgrim
authors.affiliation: Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Theokli
authors.affiliation: Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Roberts
authors.affiliation: Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Hopkins
mesh_terms: D001458:Bandages; D002425:Cautery; D002710:Chlorhexidine / Q000627:therapeutic use*; D015331:Cohort Studies; D019468:Disease Management; D004338:Drug Combinations; D004636:Emergency Service, Hospital; D004724:Endoscopy; D004844:Epistaxis / Q000175:diagnosis / Q000628:therapy*; D006782:Hospitals, Special; D006801:Humans; D008026:Ligation; D008131:London; D008485:Medical Audit; D009297:Nasal Mucosa / Q000098:blood supply / Q000601:surgery*; D059747:Nasal Surgical Procedures; D009355:Neomycin / Q000627:therapeutic use*; D010036:Otolaryngology / Q000592:standards*; D012189:Retrospective Studies; D013630:Tampons, Surgical; D062606:Tertiary Care Centers
chemical_list: D004338:Drug Combinations; C070815:Naseptin; D009355:Neomycin; D002710:Chlorhexidine