213 Improving the investigation and management of papilloedema in an acute medical setting

AimTo streamline and improve the investigation of patients with papilloedema presenting to the acute medical take in a large teaching hospital.MethodsPatients seen on the acute medical take at the Royal London Hospital with suspected papil- loedema were identified retrospectively. A total of 19 patients were seen between April and November 2019. A number of modifiable delays to initial investigations and areas for improvement were identified from these data. A simple flowchart explaining key points in investigation and initial management of patients with papilloedema was devised and distributed to those involved in the acute take.ResultsThe identified areas for improvement included delays to lumbar puncture, failure to discuss management with neurologists after identification of raised intracranial pressure, and ensuring initial management was started in those with suspected idiopathic intracranial hypertension. There were also a number of instances in which papilloedema was not confirmed by an ophthalmologist prior to inap- propriate invasive investigations. Education and provision of better information to acute medics improved many of these outcomes.ConclusionA clear and easy to use flowchart for those involved in the acute take minimised errors identified and improved the initial investigation and management of papilloedema presenting to the acute medical take.catherine.hornby2@nhs.net