EP 230 Evaluation of Acute Referral Pathways for Suspected Breast Abscess to Secondary Breast Services: A Retrospective Review at Imperial College Healthcare NHS Trust
Elizabeth Senyo, Hafsah Ba, Camilla Knight, Chien Soh, Ken Ho, Meera JoshiAbstract
Background
Breast abscesses represent a common acute presentation to emergency departments (EDs). Ultrasound-guided aspiration is the gold-standard intervention. A local ‘Breast Abscess and Mastitis Pathway’ was introduced in November 2019 to streamline referral, imaging, and management. This audit evaluates adherence to the guidelines.
Methods/Interventions
A registered retrospective audit of patients with suspected breast abscess referred from local and regional EDs to our tertiary breast unit was undertaken between October – December 2025. Patients with breast cancer were excluded. Clinical, biochemical and management data were collected from Electronic Patient Record (Cerner).
Results
18 female patients were referred with mean age 34.3 years; 45.4% (8/18) were referred internally. 78% (14/18) were lactating. All patients were seen on the day of referral – 9 patients were admitted. 50% of patients (9/18) were incorrectly referred to the breast surgery team rather than directly to the one-stop breast clinic services. Average time to ultrasound was 1.47 days. 38.9% (n=7) underwent ultrasound-guided aspiration; One patient required an emergency surgical incision and drainage. Antibiotic prescribing adhered to pathway guidance in all patients.
Conclusion
Overall compliance with local guidelines was poor, with various aspects of the pathway not being adhered to. This is potentially due to lack of awareness of the pathway and resident doctor rotational turnovers. This contributes to repeated attendances, delays to ultrasound-guided aspiration, and patient distress. The local guidelines will be updated, followed by staff education, and printed written information will be provided to support implementation. A re-audit will be carried out one month after implementation.