Consultation Intervention Rates for the Otolaryngology Service: A Large Metropolitan Hospital Experience

Treatment, Management, and Otolaryngology Consultation for Epistaxis in the Emergency Room: An Institutional Experience

BACKGROUND

Epistaxis is a common reason for emergency department (ED) visits, accounting for approximately 1 of every 200 ED visits in the United States annually and up to one-third of all otolaryngology (ENT)-related ED encounters.

OBJECTIVES

To detail reasons for ENT consultation for epistaxis in the ED, understand how consultation impacts patient care, assess follow-up patterns after emergency care, and study patient care after transfer or referral into the ED.

METHODS

Retrospective chart review of 592 adult patients with epistaxis managed in a tertiary care ED setting between 2017 and 2018. Patients with known follow-up, ENT consult in the ED, or admission were included, while patients with trauma, recent head and neck surgery, or abnormal anatomy were excluded.

RESULTS

The most common reasons for ENT consultation for epistaxis were for advanced management, referral to the ED from an outside facility or provider, and recent head and neck surgery. In total, 48.2% of patients treated for epistaxis in the ED received an ENT consultation. ENT consultation was associated with a higher likelihood of receiving absorbable or nonabsorbable packing (92.4% vs 36.1%). In total, 40.4% of patients referred into the ED from an outside facility or provider had no change in their management after receiving an ENT consult. Patients referred to the ED and White patients were significantly more likely to receive an ENT consult. Secondary analyses revealed that more White patients had an established outpatient ENT provider than patients of other races. On multivariate analysis, patients who received an ENT consult spent 75.2 min longer in the ED.

CONCLUSION

The high percentage of patients referred or transferred to the ED for epistaxis management with no change in interventions after ENT consultation indicates a continued need to develop more precise clinical care pathways. Additionally, there may be gaps between White and non-White patients in access to ENT care.

ANALYSIS OF THE RESULTS OF GP-FM QUESTIONNAIRE REGARDING TRAINING IN THE SPECIALIZATION «OTOLARYNGOLOGY» BOTH AT THE UNDERGRADUATE AND POSTGRADUATE LEVELS

OBJECTIVE

The aim: To research the degree of satisfaction with the training of general practitioners-family medicine (GP-FM) in the specialization "Otorhinolaryngology" in the leading higher educational institutions (HEIs) of Ukraine at undergraduate and postgraduate levels.

PATIENTS AND METHODS

Materials and methods: A questionnaire was conducted of 51 GP-FM doctors.

RESULTS

Results: The duration of otorhinolaryngology training at a medical HEI was indicated by: 49% of respondents about weeks of training, 19.6% - about months. 31.37% received separate training on ENT examination. 56.9% of people were trained in ENT departments. 76.5% of people were not satisfied with the quality of theoretical knowledge, 52.9% of respondents of practical skills at the undergraduate level. 72.6% of doctors not satisfied with the quality of theoretical knowledge, 56.8% of respondents of practical skills at the post-graduate level. 41.2% of respondents received post-graduate training in otorhinolaryngology at the GP-FM specialization cycle, 72.55% of them in a lecture format. 86.3% of people want to deepen their knowledge of otolaryngology and need to understand the etiopathogenetic mechanisms of ENT pathology.

CONCLUSION

Conclusions. The dissonance with the dissatisfaction of the doctors of the GPFM with the quality of the received theoretical knowledge in ENT pathology and the availability of their practical skills was revealed. It is important for GPFM doctors to undergo separate training in ENT examination and pathology with mandatory study and conscious use of etiopathogenetic mechanisms of ENT pathology, especially in inflammatory diseases.