Brit J Hosp Med
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Despite epistaxis being a common presentation to emergency departments there is a lack of guidelines, both nationally and internationally, for its management. The authors reviewed the current management of epistaxis and then introduced a new pathway for management to see if care could be improved. The aims were to evaluate the impact of the pathway on reduction of emergency department breaches, emergency ambulance transfers and hospital admissions. ⋯ The authors calculate that these results equate to roughly 56 hospital bed days saved, providing better care closer to home for patients, in addition to beneficial knock-on effects for other emergency department and admitted patients.
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A well thought-out business case offers an opportunity for clinicians to bring about evidenced-based change in clinical practice. It is a powerful tool that can have a significant impact on healthcare services and patient outcomes, while also offering desirable solutions to the NHS, which is facing growing healthcare demands on increasingly limited resources. ⋯ This article guides clinicians through the process of producing a successful business case using the five-case model, which can be applied to the majority of improvement projects or services in healthcare settings. Clinicians might use this guide to support the development of a case to make a change in their own workplace or to help them take a full part in wider system changes.
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This year marks the 150th anniversary of the birth of Grafton Elliot Smith, the distinguished Australian-born anatomist and an early expert on the excavations of ancient Egypt.
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The coagulopathy of chronic liver disease causes derangement of the results of traditional laboratory tests. As such, there is an expectation that when undergoing invasive procedures patients with cirrhosis are at increased risk of bleeding. Standard practice is to optimise laboratory values with prophylactic transfusions of platelets, plasma and fibrinogen to reduce perceived bleeding risk. ⋯ Guidelines for the preprocedural management of patients with chronic liver disease are inconsistent and may not account for this new paradigm. The risk of prophylactic transfusion should be measured against the risk of bleeding while considering the rebalancing of haemostasis. Future management may be guided by whole blood viscoelastic tests or use of thrombopoietin receptor agonists to optimise patients in these scenarios.