ENT UK Research Articles

Comment on: Assessing the Quality and Readability of Online Patient Information: ENT UK Patient Information e-Leaflets vs Responses by a Generative Artificial Intelligence.

Comment on: Assessing the Quality and Readability of Online Patient Information: ENT UK Patient Information e-Leaflets vs Responses by a Generative Artificial Intelligence.

Assessing the quality and readability of online patient information: ENT UK patient information e-leaflets vs responses by a Generative Artificial Intelligence.

The evolution of artificial intelligence has introduced new ways to disseminate health information, including natural language processing models like ChatGPT. However, the quality and readability of such digitally-generated information remains understudied. This study is the first to compare the quality and readability of digitally-generated health information against leaflets produced by professionals. Patient information leaflets for five ENT UK leaflets and their corresponding ChatGPT responses were extracted from the Internet. Assessors with various degree of medical knowledge evaluated the content using the Ensuring Quality Information for Patients (EQIP) tool and readability tools including the Flesch-Kincaid Grade Level (FKGL). Statistical analysis was performed to identify differences between leaflets, assessors, and sources of information. ENT UK leaflets were of moderate quality, scoring a median EQIP of 23. Statistically significant differences in overall EQIP score were identified between ENT UK leaflets but ChatGPT responses were of uniform quality. Non-specialist doctors rated the highest EQIP scores while medical students scored the lowest. The mean readability of ENT UK leaflets was higher than ChatGPT responses. The information metrics of ENT UK leaflets were moderate and varied between topics. Equivalent ChatGPT information provided comparable content quality, but with reduced readability. ChatGPT patient information and professionally-produced leaflets had comparable content, but LLM content were required a higher reading age. With the increasing use of online health resources, this study highlights the need for a balanced approach that considers optimises both the quality and readability of patient education materials.

Auditory processing disorder: an online survey of hearing healthcare professionals’ knowledge and practices

Objective To investigate (1) the current level of awareness and knowledge on Auditory Processing Disorder (APD) among Audiologists and other hearing healthcare professionals; (2) current practices in screening, diagnosis, and management of APD in children and adults across the UK; (3) professional’s acceptance of APD assessment and diagnosis. Design An online survey was disseminated through the British Academy of Audiology and ENT UK. Study sample A total of 191 hearing healthcare professionals responded to the survey. Results Overall, while 63% of the respondents considered themselves to be adequately informed about APD, only 4% viewed themselves as very informed on the topic. Fewer than half of the respondents report screening (31%), diagnosing (14%), or managing (36%) cases of APD. For screening APD, professionals most commonly use auditory processing tests in adults and take case histories in children, whereas routine audiological procedures are the primary method for diagnosing APD in both adults and children. Although modifying the listening environment is a widely recommended management strategy for APD, half of the respondents indicated that a diagnosis of APD has no implications for patient management. Conclusions There is a critical need to promote APD-related training to ensure they can provide appropriate referrals and management.

The quality and readability of patient information provided by ChatGPT: can AI reliably explain common ENT operations?

Access to high-quality and comprehensible patient information is crucial. However, information provided by increasingly prevalent Artificial Intelligence tools has not been thoroughly investigated. This study assesses the quality and readability of information from ChatGPT regarding three index ENT operations: tonsillectomy, adenoidectomy, and grommets. We asked ChatGPT standard and simplified questions. Readability was calculated using Flesch-Kincaid Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI) and Simple Measure of Gobbledygook (SMOG) scores. We assessed quality using the DISCERN instrument and compared these with ENT UK patient leaflets. ChatGPT readability was poor, with mean FRES of 38.9 and 55.1 pre- and post-simplification, respectively. Simplified information from ChatGPT was 43.6% more readable (FRES) but scored 11.6% lower for quality. ENT UK patient information readability and quality was consistently higher. ChatGPT can simplify information at the expense of quality, resulting in shorter answers with important omissions. Limitations in knowledge and insight curb its reliability for healthcare information. Patients should use reputable sources from professional organisations alongside clear communication with their clinicians for well-informed consent and making decisions.

943 An Audit of the Management of Necrotizing Otitis Externa Within Royal Devon and Exeter Hospital

Abstract Aim To improve recognition and management of necrotizing otitis externa (NOE) early to prevent disease progression and reduce hospital admissions/length of stay. Method A retrospective audit of patients who were treated for NOE during an inpatient admission to the Royal Devon and Exeter Hospital between 1st December 2020 and 1st June 2022. Results A total of 15 cases were identified where symptoms were not attributable to an alternative diagnosis. Lab results, inpatient and clinic attendances were analysed to identify areas of improvement in terms of investigations and management. The mean number of presentations before admission was 2.3. At admission 66% of patients had a swab taken and 7% of patients had imaging. Systemic antibiotics were prescribed in 20% of patients before admission. IV antibiotics were started within 24 hours in all patients admitted. Microbiology consults were sent within 6 days in 93% of cases. The mean duration of IV antibiotics was 13 days, and the mean inpatient stay was 19 days. Conclusions The incidence of NOE is increasing in the UK, yet there is limited guidance and consensus on diagnosis and management. Some advice is provided by ENT UK, who suggest outpatient recognition might be improved by ensuring swabs and imaging are completed to reduce hospital admissions. In lower risk cases, starting oral ciprofloxacin may then aid with management. On admission investigations and management are being promptly started; however, an area for improvement could be the potential introduction of long lines for outpatient IV antibiotic therapy to reduce the length of hospital stays.

1208 Post-Tonsillectomy Re-Admissions – a Real Pain in the Mouth for Our Patients

Abstract Aim Uncontrolled post-tonsillectomy pain is detrimental to patient safety and recovery, increasing the risk of morbidity from complications such as infection and secondary haemorrhage. A closed-loop audit of the adult and paediatric population evaluated operative and post-operative factors, and readmission and return to theatre rates against the National Prospective Tonsillectomy Audit (NPTA) and ENT UK Tonsillectomy Commissioning standards. Method Data from seventy-one and forty-three patients were collated over two treatment quarters in 2019/2020, including operative indication, surgical grade, dissection technique, estimated blood loss and local anaesthetic infiltration, in addition to post-operative analgesia instruction, length-of-stay, and discharge medications. Incidences of re-presentation within thirty days were reviewed, assessing the nature of complaint and indication for readmission. Inter-cycle intervention involved departmental education and dissemination of post-operative verbal/written patient education. Results Overall readmissions (15.5%), pain readmissions (1.4%/n = 1) and return to theatre cases (2.8%) exceeded national standards in cycle one (<15%, <1%, <1%), improving to standard in all domains bar pain readmission in cycle 2 (9.3%, 2.3%/n = 1, 0%). Length-of-stay was compliant throughout (0.2, 0.1 days). Documentation of post-operative analgesia instruction and simple and opiate discharge medication prescription in both adult and paediatric populations improved post-intervention (83% to 98%). Conclusions Scheduled, multimodal analgesia and discharge education that sets realistic expectations post-operatively are key in optimising the post-operative safety of our patients. In addition to verbal and written education, collaborative work with pharmacist colleagues to create and standardise a post-operative pain protocol and discharge analgesia pack will support and empower patients to enhance post-operative recovery and minimise avoidable hospital admission.

Clinical practice guidelines for management of head and neck squamous cell carcinoma of unknown primary: an AGREE II appraisal.

Squamous cell carcinoma without a known primary is an uncommon form of head and neck cancer that requires multidisciplinary collaboration for effective management. To evaluate the quality of clinical practice guidelines (CPG) using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. A systematic literature search was performed to identify CPGs pertaining to the diagnosis and treatment of head and neck squamous cell carcinoma of unknown primary (HNSCCUP). Data were abstracted from guidelines meeting inclusion criteria and appraised by four independent reviewers in the six domains of quality defined by the AGREE II. Online database. None. None. Quality domain scores and intraclass correlation coefficients (ICC) were calculated across domains to qualify inter-rater reliability. Seven guidelines met inclusion criteria. Two guidelines achieved a score of > 60% in five or more AGREE II quality domains to gain designation as 'high'-quality content. One "average-quality" guideline authored by the ENT UK Head and Neck Society Council achieved a score of > 60% in three quality domains. The remaining four CPGs demonstrated low-quality content, with deficits most pronounced in domains 3 and 5, suggesting a lack of rigorously developed and clinically applicable information. As the diagnosis and treatment of head and neck cancer continues to evolve, identification of high-quality guidelines will become increasingly important. The authors recommend consulting HNSCCUP guidelines from the National Institute for Health and Care Excellence (NICE) or the American Society of Clinical Oncology (ASCO). None.

1010 Audit of Acute Management of Sudden Onset Sensorineural Hearing Loss and Streamlining of Local Management Pathway

Abstract Aim Sudden onset sensorineural hearing loss (SSNHL) presents infrequently to ENT services in Aberdeen Royal Infirmary. Although ENT UK guidelines are in place for the management of SSNHL, the practicalities of organising these cases within our department can be challenging to junior staff leading to variation in time to review and timings of intervention. We Aimed to assessed current local practice in comparison compare it to national ENT UK guidelines Method Retrospective audit of 6 months data set recording management pathway of patients presenting with SSNHL to Rapid Access Clinic of Royal Aberdeen Infirmary Hospital. Electronic patient records were searched for: time of referral, duration of symptoms, times to first ENT review, intervention and audiogram, and timings and management during subsequent reviews. Results Seven patients meeting the inclusion criteria were identified and included in the audit. Average times from referral were calculated including time from referral to intervention (1.47 days), from referral to first ENT review (3.82 days), from referral to first audiogram (4.43 says). Average time from presentation to starting oral steroids was very efficient of just 0.33 days and average time from symptom onset to oral steroids initiation was 7.5 days suggesting late patient presentation. Conclusions The data gather helped our department to reinforce management pathway of SSNHL as per ENT UK guidelines and improved the way urgent audiograms are organised in the hospital. It also emphasised the importance of performing tuning fork test to determine the nature of hearing loss when audiogram is not immediately available.

326 Is Patient Satisfaction Affected by Replacing Face-to-Face Appointments with Telephone Assessments for Balance Complaints?

Abstract Aim It was found that 91% of surgeons conducted virtual consultations during COVID-19 pandemic. In March 2020, ENT UK recommended that telephone review should be the first approach for all outpatients who do not need urgent treatment. Dizziness diagnoses may be made primarily from the medical history, making telephone clinics suitable. This study aims are to determine the level of patient satisfaction with telephone consultations for balance complaints. Method The electronic patient records of ENT patients were reviewed retrospectively to identify all adult patients with first presentation of dizziness between October 2020 and May 2021.Patients were contacted by telephone and completed the short form patient satisfaction questionnaire (PQS-18). The statistical software SPSS was used for analysis. Results 26 out of 37 patients contacted were reached successfully giving a response rate of 70%. There were 12 patients in the telephone consultation group and 14 patients in the face-to-face group. Average general satisfaction and satisfaction with technical quality were lower in the telephone consultation group (p-values of 0.012 and 0.007 respectively). Total average score was also lower in telephone consultation group with p-value of 0.028. 91% of patients who had initial assessment by telephone needed a follow up face to face consultation as opposed to only 14% in the face-to-face group. Conclusion Patients were less satisfied with primary assessment of balance complaints by telephone. Most of these patients required face-to-face follow up consultations.

432 Improving the Use of Acute ENT Clinic in a DGH During the COVID19 Pandemic

AimThe SHO led acute ENT clinic is used to assess and treat a variety of ENT pathology. Following the COVID19 pandemic, the department has seen an increase in referrals for conditions that do not meet departmental guidelines. To meet demand, our clinics were always overbooked and over running as juniors sought help from seniors for more complex referrals.MethodA quality improvement project was initially set to be performed over a few months; however, due to COVID, data was collected over a year from December 2019 to 2020. We looked specifically at number of patients referred, reason for referral, number of follow-up appointments, senior review required and how COVID affected the running of the clinics.ResultsCompared with the clinic's standard operating procedure, 77.2% of clinics were overbooked and 69.8% of patients had unsuitable referrals. This prompted changes such as increasing clinic capacity by introducing full day clinics and increasing senior support by moving to the outpatient department, then clinics were only overbooked 1% of the time. Other areas for improvement highlighted such as advice given to patients as well as referral to main ENT clinic.ConclusionIt was clear that the capacity of the acute clinic did not meet demand, and this was needed to ensure patient safety and adhere to ENT UK guidance. We implemented a more stringent referral system to increase patient safety by ensuring patients with appropriate pathology are seen in this clinic or referred to other relevant clinics where they can be seen earlier by seniors.

Safety of Otological Operating During the COVID-19 Pandemic: A National Prospective Audit of 1130 Cases from 79 Centers.

To assess compliance with guidance produced by the UK body representing all ENT Surgeons (ENT UK) and the British Society of Otology (BSO) on restarting otological surgery after the first wave of the COVID-19 pandemic. Safety was assessed by recording surgical complica- tions and transmission of SARS-CoV-2 transmission during this period. A prospective multicenter audit of otological surgery was conducted over a 12-week period, from June 15, 2020, to September 6, 2020. One thousand one hundred thirty cases from 79 hospital sites across Great Britain were involved in the study; 91.1% were tested for SARS-CoV-2 pre-operatively, none of whom tested positive; 70.4% were isolated for 7-14 days prior to surgery; 28.2% of surgeons wore full personal protective equipment, compared with 66.6% of anesthetists and 68.2% of scrub staff. The endoscope was used in 75 (6.7%) of all proce- dures, operations were changed to be performed under local rather than a general anesthetic in 3 cases (0.3%) and the "double drape" to protect against aerosol was used in 321 (27.4%) of cases. Trainees were present in 80.3% of cases. Complications occurred in 4% of cases. No patients or staff contracted SARS-CoV-2 during the audit. ENT UK and BSO guidance was variably followed, with the highest compliance for the use of an FFP3 mask, a negative SARS-CoV-2 swab, and trainee presence in theater. Surgeons did not use full personal protective equipment as frequently as their anesthetic and scrub team colleagues. There were only minimal changes in surgical and anesthetic techniques. Otological operation after the first wave of the SARS- CoV-2 pandemic was performed safely with no reported COVID transmission or increase in major complications despite changes in operating practice.

Audit of flexible laryngoscopy use and decontamination using a chlorine dioxide wipe system during COVID-19: Assessing the risk of disease transmission

SummaryAimTo assess the efficiency of decontamination of flexible nasoendoscopes using a chlorine dioxide wipe system and assessing the risk of disease transmission during the COVID-19 pandemic.MethodProspective and retrospective review of 544 patient episodes of nasoendoscopy and a study of 41 patient procedures and 22 members of staff at an ENT Outpatient Department from September 2020 to March 2021.ResultsAmong 41 randomly selected episodes of nasoendoscopy in the clinic, there was 93%–100% compliance with decontamination guidelines suggested by ENT UK. Among 544 patients who had nasoendoscopies, 20 had RT-PCR tests within two weeks and all yielded a negative result; no clusters of consecutive endoscopies were noted. None among the 22 clinic staff had symptoms of COVID-19 infection during the study period.ConclusionAccepting the limitations of the study design, this audit found no evidence of nosocomial transmission of SARS-CoV-2 virus related to use or reprocessing of flexible nasoendoscopes among patients and staff following good compliance to ENT UK decontamination guidelines.

The use of cone beam computed tomography of paranasal sinuses in the investigation and management of rhinosinusitis: a national survey and our ‘one-stop’ rhinology clinic experience

Cone beam computed tomography is an imaging technique that can be used for the paranasal sinuses. This study assessed how widely it is used and the impact it has on chronic rhinosinusitis management in the ENT department of one hospital. A nationwide survey was conducted to assess the use of cone beam computed tomography throughout ENT UK members. A retrospective analysis of four-year rhinology clinic data for patients presenting with chronic rhinosinusitis symptoms was subsequently performed to assess how many scans were achieved the same day and the subsequent patient management. The survey results indicated that a majority of staff do not use cone beam computed tomography to image sinuses (86.5 per cent), and this was largely because of lack of access (92 per cent). This study assessed 355 cone beam computed tomography requests. Overall, 306 cases had a cone beam computed tomography scan on the same day as their clinic appointment with the majority seen back in clinic during the same hospital attendance for the results. Overall, 97 patients were discharged on the same day. This study suggested a lack of awareness and understanding of cone beam computed tomography in managing rhinosinusitis. The 'one-stop' rhinology clinic model offers benefits including reduced patient hospital attendance.

TP8.2.17 Supplementing Undergraduate ENT Teaching: A Neglected Surgical Speciality?

Abstract Aims A 2020 survey of undergraduate ENT education found there was wide variability between Medical Schools despite a standardised curriculum, published by ENT UK. To improve this, a group of CTFs designed and led teaching sessions covering each aspect of ENT based on the ENT UK curriculum. The aim was to improve confidence in and knowledge of ENT conditions expected at junior doctor level. Methods Final year students participated in three 1-2 hour teaching sessions focused on ‘Otology’, ‘Rhinology’ and ‘Head & Neck’. Each session started with an MCQ assessing prior knowledge, with a post-teaching MCQ to assess for improvement. There was an additional questionnaire to measure confidence in several domains pre- and post-teaching, and of the undergraduate teaching they had received within their medical schools. Results Overall, students’ pre-ENT teaching and post-ENT teaching MCQ scores improved from 67% to 87%. The percentage of students who felt ‘fairly confident’ and/or ‘completely confident’ in the following domains were compared pre- and post-teaching respectively: recognising ENT conditions (26% vs 42%); managing & treating ENT conditions (5% vs 42%); and recognising surgical airways (3% to 40%). 47% of students found tutorials based on ENT ‘very useful’ for their learning, compared to 16% for outpatient clinics & lectures. 94% of students had received ENT teaching for a period of < 2 weeks, with 37% of those receiving <1 week. Conclusions This project demonstrates how a small series of curriculum specific ENT teaching can help final year students to supplement their knowledge and confidence in ENT.

749 Unexpected benefits of pandemic guidelines for the management of epistaxis

AimThe Royal Victoria Hospital adopted ENT UK’s pandemic guidelines for the management of epistaxis. We aimed to reduce ENT referrals, in-patient admissions and staff exposure to COVID-19 whilst maintaining patient safety. This involved collaboration with ED to promote the use of absorbable packs and pharmacological alternatives over rhinoscopy & rigid endoscopy with cautery +/- non-absorbable packs.MethodData was collected on patients presenting with epistaxis over a six-week period beginning March 2020 and the same period in 2019. Key factors recorded were number of presentations, ENT referrals, admissions, and their durations, along with management and outcomes. ENT provided training to ED staff and produced video resources for the "My ED" app. Feedback from ED and patient data was gathered to improve training and assess effectiveness.ResultsPre-pandemic, 48% of ED epistaxis presentations were referred to ENT vs. 28% following the guidelines introduction. In 2019 49% of referrals were admitted vs. 42% in 2020. The average in-patient stay was reduced from four nights to one. Re-admission rate remained similar from 22% in 2019 to 20% in 2020. These results were achieved following repeated improvements to the training sessions.ConclusionsThe ENT UK guidelines, when supplemented with ED collaboration, are effective at reducing ENT referrals and admissions. In addition to reducing COVID-19 exposure, the guidelines offered an improved patient experience (less invasive intervention, reduced/removed in-patient stay) with no loss of efficacy. This, combined with a reduced treatment cost of ∼£2,000 per in-patient, suggests the guidelines have long-term value out-with a pandemic setting.

894 An Audit of Venous Thromboembolism Prophylaxis in A Busy ENT Department

Abstract Aim Venous thromboembolisms (VTEs) are a common and preventable cause of in-hospital morbidity and mortality. Assessment of risk factors (RFs) on admission and appropriate prescription of mechanical (e.g., TEDS) and/or pharmacological prophylaxis (e.g., low-molecular-weight heparin (LMWH)) is crucial. This is especially true in ENT where the variety of patient cohorts make a one-size-fits-all approach unsatisfactory. Guidelines from ENT UK reflect this. Method Electronic medical records were retrospectively reviewed for all emergency and pre-operative admissions (n = 173) to an adult ENT ward over 8 weeks. Adherence to the ENT UK guideline was assessed. Results 58% of patients had VTE RFs, 27% had bleeding RFs, 2% had mechanical thromboprophylaxis contraindications. VTE risk assessment was clearly carried out for 39% of admissions. 63 patients (36%) met the criteria for LMWH prescription. 22 (35%) received it. 5 received LMWH without meeting the criteria. 96 patients (55%) met the criteria for TEDS prescription. 5 (5%) received it. 1 received TEDS without meeting the criteria. Overall, 45% of admissions had both prescribed according to the guideline. Using a pro-forma (n = 148) significantly improved risk assessment rates (43% vs. 12%), but not correct prescription rates (45% vs 40%) compared to freehand clerking (n = 25). No patients developed a VTE or unexpected bleeding. Conclusions Risk assessment and prescription of pharmacological and, especially, mechanical thromboprophylaxis for those who met the relevant criteria has significant room for improvement. However, no apparent harm occurred because of this. Further work will focus on developing a departmental policy and educating staff on its application.

686 Evaluating and Modernising the Management of Nasal Trauma in Emergency ENT Clinic

Abstract Aim 1. Optimise and compare management of nasal fractures at a single UK based centre with nationally excepted standards from ENT UK and published literature. 2. To measure the non-attendance (DNA) rate in the emergency ENT clinic for patients with nasal trauma. 3. To assess the ratio of face to face (F2F) appointments to patients listed for a manipulation under anaesthesia MUA. 4. To provide additional insight into the aetiology of nasal trauma Method Retrospective analysis of clinical notes for all nasal traumas reviewed in the ENT emergency clinic at a single centre from 1st July 2019 – 1st March 2020. Parameters investigated included – demographics, days from injury, F2F:MUA, DNA rate and aetiology of injury. Implementation of a video-based clinic and local anaesthetic MUA clinic. Results At total of 255 patients and 311 appointments notes were reviewed in this period. DNA rate was found to be 28%. F2F:MUA was found to be 4:1. Patients were reviewed on average 9 days post-injury. Most common causes of trauma were assault (39%), fall (31%), sport (13%), accidental hit (10%). Conclusions The DNA rate was found to be 20% higher than the national average for outpatient clinics and a F2F:MUA of 4:1 displays a high burden of unnecessary F2F contact. A video-based and local anaesthetic nasal fractures clinic has been implemented to combat these issues which will be re-audited.

1648 Is Telephone Triage Here to Stay? An Audit of The Impact of COVID 19 On A Head and Neck Cancer Clinic

Abstract Due to the COVID19 pandemic, NHS reported a 60% drop in suspected cancer referrals and a delay in treatment initiation. In a pandemic, cancer waiting time (WT) targets can prove difficult to achieve. ENT UK and NHS England recommended a senior-led telephone triage system to be put in place in response to the pandemic. Aim of this audit was to assess the impact of the pandemic and evaluate the efficacy of tele-consults on the Head & Neck Cancer (H&N) Service at a District General Hospital. A retrospective audit of patients referred to the H&N clinic from April - June 2020, comparing patients managed by teleconsultations to patients seen F2F. Medical records were analysed to assess compliance with NHS Cancer WT targets. 2020 saw a 1.4% drop in referrals compared to 2019. Of the 224 referrals received from April - June 2020, 96.9% were seen within 14 days. 98.7% were initially reviewed by telephone, 37% of which were triaged to a F2F appointment, 39% were followed up by telephone and 24% were discharged or given routine appointments. 11.2% were diagnosed with cancer. Comparing cancer patients managed by telephone to patients seen F2F, 80% v 57% received a diagnosis by 28 days from the referral, and 100% v 17% started treatment by 62 days. The department did not have a significant drop in referrals due to the COVID pandemic. Cancer patients managed by telephone were more likely to start treatment within 62 days. Telephone consults should be a permanent feature of cancer clinics beyond the pandemic.

1508 Acute ENT Clinic Audit

Abstract Introduction The acute ENT clinic is run by the ENT SHO’s and is used to assess and treat patients with a variety of everyday ENT pathology. As a department, we are seeing increasing numbers of patients who have been referred via the community for conditions that do not meet the departmental guidelines as well as noting our clinic is consistently overbooked and overrunning. Method A retrospective audit was performed analysing all clinic data between December 2019 and January 2020, specifically looking at patient demographics and reason for referral. The total number of patients per clinic was analysed and compared against ENT UK guidelines for safe clinic numbers, which state that an SHO led acute clinic should have 6 patients maximum. Results Over a two-month period, we looked at data from 35 clinics. As per our standard operating practice, children should be seen first in the clinic and this occurred in only 8 clinics (22.9%). Secondly, 8 clinics had appropriately booked a maximum of 6 patients, whilst in 27 clinics (77.2%) there were more than 7 patients booked. Finally, 69.8% of patients had unsuitable referrals as per the guideline. Conclusions It is clear from our data that the capacity of the acute clinic does not meet its current demand, and this is something that needs to be addressed to ensure patient safety and to adhere to ENT UK guidance. The implementation of a more stringent referral system will increase patient safety by ensuring patients with appropriate pathology are seen in this clinic.

168 Emergency Medicine Clinicians’ Confidence in Managing Epistaxis Is Improved by A Simple Intervention: A Closed-Loop Quality Improvement Study

Abstract Aim Epistaxis is a common, potentially life-threatening presentation in the Emergency Department (ED) with an incidence of 108/100 000 population per year. 85% of all patients presenting with epistaxis are managed by ED clinicians without specialist input or admission. Guidelines exist from ENT UK on epistaxis management, however awareness of these guidelines, nuances in techniques and levels of confidence by ED clinicians is not known. This quality improvement study aims to assess the confidence of ED clinicians in managing epistaxis, and investigate whether this could be improved through educational intervention. Method A single-centre, prospective, baseline audit was conducted following local approval. An initial questionnaire assessed knowledge of appropriate Hippocratic first aid method for epistaxis, alongside individual confidence in providing epistaxis prevention advice. The educational intervention included a 30 minute interactive tutorial on epistaxis during the local department teaching for ED clinicians. The audit loop was then closed by repeating the questionnaire. Results Pre- (n = 20) and post- (n = 8) intervention questions were completed by ED clinicians. Knowledge scores of appropriate epistaxis first aid provision increased from 53% pre-intervention to 88% post-intervention. Reported confidence in providing epistaxis prevention advice also increased from a mean score of 2.7 pre-intervention to 4.1 post-intervention on a 5-point Likert scale. Conclusions ED clinicians generally lack knowledge on appropriate first aid techniques on managing epistaxis and confidence in providing epistaxis prevention advice. Both of these parameters may be improved by simple educational interventions which may be implemented nationally.