144 Title: A Repeat Cycle Closed Loop Audit Reviewing Emergency Department Referrals for Nasal Trauma to a Major ENT Centre; Practice Standards for Safe Care

Background Facial trauma is a very common presenting complaint In Emergency care, referrals to ENT Emergency clinics (EC) without proper assessment risks complications and unnecessary clinic appointments. Complications that can follow nasal trauma include, septal haematoma, infraorbital nerve trauma and nasal blockage. Aim To assess clinical practice when reviewing nasal trauma and provide education and guidance to assist these reviews. Method A closed loop 3 cycle audit reviewed the documentation of clinical reviews for patients referred to ENT EC with nasal trauma. Cases were reviewed for assessment of septal haematoma, Infraorbital nerve trauma and airflow symptoms. Data was collected, analysed, and presented at the ED departmental teaching and morning board rounds. Data was then re-audited. A new trust guideline was uploaded to the ED guidance application and data was Re-audited. Each period of data collection covered 31 days. Results A total of 137 patients were included. Prior to the first intervention referrals were 26% higher than in both repeat cycles. Documentation of septal haematomas and airflow symptoms improved fractionally, increasing from 79% to 85% and 32% to 33% respectively. Infra-orbital nerve status was reviewed in 5% more patients after implementation of new trust guidelines. Conclusions Complications of nasal fractures are poorly assessed. Small improvements can be made with departmental teaching, but these changes will likely be temporary given the high staff turnover in ED. Implementation of clear guidelines can promote lasting change. This study demonstrates the benefit of continued education and pathway development on precision care while reducing burden on outpatient clinics.