Doctor, I really need a prescription! - Antibiotic Prescribing in Children

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Background: There remains variation in epistaxis management across the UK. Some units discharge selected patients with nasal packs in situ, for 24-48 hour outpatient review. With increasing hospital pressures and new national guidelines, it is time to review whether this is safe and practical management. Aims: Identify patients eligible for discharge with packs in situ, and quantify potential bed savings. Methods: Retrospective study of patients presenting to A&E with epistaxis between Jan 2014-Jan 2015 (N=365, mean age 55yrs). Consensus meeting between all 3 departments agreed criteria for discharge on new pathway (Fig1) Criteria for discharge with pack in situUnilateral Pack onlyNo posterior bleed, no rebleedingNot on warfarin, clopidogrel, or NOACsNo major cardio-respiratory diseaseNo frailty/social issuesHb & Clotting normalObservations stableFig 1Results: 29.0% (n=106) were admitted, with mean length of stay 2.8 days. Of these 26.4% (n=28) were eligible for discharge on the new pathway, with saving of 78.4 bed days. No low risk patients re-bled or were readmitted.Conclusions: Whilst the number of patients eligible is small, there is significant potential for cost savings whilst managing patients safely.

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