Improving the quality of assessment and management of nasal trauma in a major trauma centre (MTC): Queen Elizabeth Hospital, Birmingham

[摘要] Background Nasal fractures present in 39% of patientswith facial trauma. These patients are assessed in theemergency department followed by outpatient reviewin the senior house officer-led emergency ear, nose andthroat (ENT) clinic. Inadequate treatment of nasal traumacan result in debilitating functional and aesthetic problems.Inexperienced junior doctors may be apprehensive inassessing nasal trauma resulting in time pressured clinicsand suboptimal management.Measures A retrospective review of clinical noting over3 months was carried out to gauge the extent of theproblem. Three baseline measurements for satisfactoryquality of assessments included: (1) 3/5 key symptomselicited by the clinician (epistaxis, rhinorrhoea, nasalairway obstruction, dental malocclusion and diplopia).(2) Presence/absence of ‘septal haematoma’ (SH) and‘deviated nasal septum’ (DNS) documented. (3) Patientfollow-up within 2 weeks after the initial injury. ThreePlan-Do-Study-Act (PDSA) cycles were conducted withimplementation of interventions (proforma, clinic poster,patient information leaflet and training) as visualised in our‘driver diagram’.Results The quality of nasal trauma assessmentsimproved following each intervention. There was anincrease from 86% to 100% patients being seen within 2weeks of the injury. There was an improvement in qualityof assessments following the teaching as two-thirds(PDSA cycle 2) followed by 100% (PDSA cycle 3) of clinicaldocumentation included ‘rhinorrhoea’ and 83% (PDSAcycle 2) to 100% (PDSA cycle 3) included ‘nasal airwayobstruction’. Similarly, two thirds (PDSA cycle 2) followedby 100% (PDSA cycle 3) examined and documented thepresence/absence of SH and DNS. A 100% improvement intrainee confidence was reported. We are now conductingmore comprehensive assessments of nasal traumapatients.Conclusion The need to provide relevant trainingand support to ENT junior doctors is crucial in theirdevelopment, as well as to ensure delivery of high-qualitypatient-centred care.

[学科分类] 药学