s / International Journal of Surgery 10 (2012) S1–S52 S35 ABSTRACTS unnecessary withholding of anticoagulant and antiplatelet medication with no statistically significant increase in complication rates (increased admission, DVT, PE, re-admission with bleeding following discharge). Conclusion: No guidelines currently exist within the literature on the management of antiplatelet or anticoagulant use in epistaxis patients; therefore this audit is significant in that respect. Current data from re-audit has shown favourable results and full results will be available for presentation in March 2012. 0237: WHAT IS THE VALUE OF A ‘ONE-STOP' CLINIC IN ASSESSING TWO WEEK WAIT NECK LUMP REFERRALS? Arunjit Takhar , Michael Jones , Ram Vaidhyanath , Peter Conboy , Tom Alun-Jones . Department of Otolaryngology, University Hospitals of Leicester NHS Trust, Leicester, UK; Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK Aim: To assess our surgeon and radiologist ‘one-stop' clinic compared to conventional head and neck clinic in the assessment of neck lumps. The ‘one-stop' service has provision for ultrasound examination and guided fine needle aspiration. Method: Retrospective analysis of all patients referred with a lump under the two week wait from 8th November 2010 31st January 2011. Results: A total of 72 new patients were seen, 26.4% of which were assessed in our ‘one-stop' service. The average time to diagnosis was 29.5 days in a standard head and neck clinic compared to 10.7 days in our onestop clinic (p1⁄40.003). The average number of outpatient appointments required tomake a diagnosis was 2.0 in the standard clinic compared to 1.5 in the ‘one-stop' service (p1⁄40.014). The longest time to cancerous diagnosis was 107 days in our standard clinic compared to 11 days in the 'one-stop' service. Conclusion: The ‘one-stop' model of assessing patients with neck lumps leads to significantly shortened time to diagnosis and fewer follow-up appointments providing mutual benefit to both patients and limited NHS resources. This has lead to a restructuring of our outpatient services with the objective that all neck lumps are assessed in a ‘one-stop' clinic. 0259: INTRADEPARTMENTALVARIABILITY IN FINE NEEDLE ASPIRATION TECHNIQUE AND CYTOLOGICAL DIAGNOSTIC ADEQUACY RATE IN THYROID AND NECK MASSES Vinay Varadarajan , Edward Ridyard . North West Higher Surgical Training Scheme, Manchester, UK; 2 The University of Manchester Medical School, Manchester, UK Aims: To assess variability in fine needle aspiration (FNA) technique and diagnostic adequacy rate amongst surgeons sampling thyroid and neck masses. Methods: A retrospective single-blinded analysis of all surgeons' FNA results was undertaken after consent. Sample adequacy was defined as enough cells to establish a firm cytological diagnosis. KolmogorovSmirnoff testing confirmed normal distribution in the data set. Results: A total data set of n1⁄470, represented the ten most recent FNA results of the seven surgeons included. Marked variability in technique existed amongst all surgeons. The diagnostic rate ranged from 80% to 30% with a departmental average of 52.7%. T-testing showed two surgeons achieved a significantly higher diagnostic rate (P1⁄40.007 and P1⁄40.045) and one surgeon had a significantly lower rate (P1⁄40.015) compared to the departmental average. The highest diagnostic rates were achieved using the same technique. Experience of surgeon was not a causal factor and correlation coefficient testing revealed no statistical difference between needle size (P1⁄40.348) and number of samples per patient (P1⁄40.348). Conclusions: There may exist a marked variability in FNA technique and success rate within a unit. Cytological adequacy rates are more dependent on technique rather than experience. We encourage others to monitor their FNA adequacy rates and technique. 0293: ENT EMERGENCY CLINIC ACTIVITY Jagdeep Virk, Behrad Elmiyeh, Arvind Singh. Northwick Park Hospital,