{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T10:40:00Z","timestamp":1764240000791,"version":"build-2065373602"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,7,22]],"date-time":"2016-07-22T00:00:00Z","timestamp":1469145600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>We compare the management of patients with severe epistaxis before and after the implementation a clinical care pathway (CCP) to standardize care, minimize hospital stay, and decrease cost.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Single prospective analysis with historical control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary academic hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects and Methods<\/jats:title><jats:p>Patients treated for epistaxis between October 2012 to December 2013 were compared with a prospective analysis of patients treated for severe epistaxis after implementation of a CCP from June 2014 to February 2015. Severe epistaxis was defined as nasal bleeding not able to be controlled with local pressure, topical vasoconstrictors, or simple anterior packing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Severe epistaxis was similar in the pre\u2010 and post\u2010CCP cohorts: 24.7% (n = 42) vs 18.9% (n = 22), respectively. Implementation of early sphenopalatine artery ligation resulted in decreased number of days packed (3.2 \u00b1 1.6 to 1.4 \u00b1 1.6; <jats:italic>P<\/jats:italic> =. 001), decreased hospital stay (5.2 \u00b1 3.9 to 2.1 \u00b1 1.3\u00a0days; <jats:italic>P<\/jats:italic> &lt;. 001), an increased percentage of sphenopalatine artery ligations (31.0% vs 54.5%; <jats:italic>P<\/jats:italic> =. 035), admission to an appropriate hospital location with access to key resources (41.7% vs 83.3%; <jats:italic>P<\/jats:italic> =. 007), and decreased overall cost of hospitalization by 66% ($9435 saved). No patients received embolization after the CCP was implemented.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Implementation of a CCP decreased hospital stay and days of packing, facilitated definitive care in patients with severe epistaxis, improved patient safety, and decreased cost. The results of this study can serve as a model for the management of severe epistaxis and for future quality improvement measures.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599816657045","type":"journal-article","created":{"date-parts":[[2016,6,29]],"date-time":"2016-06-29T03:06:36Z","timestamp":1467169596000},"page":"879-885","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Successful Implementation of a Clinical Care Pathway for Management of Epistaxis at a Tertiary Care Center"],"prefix":"10.1002","volume":"155","author":[{"given":"Peter S.","family":"Vosler","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason I.","family":"Kass","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck 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