Introduction: Acute mastitis and/or breast abscess are frequently managed by non-specialist Accident and Emergency staff and General Surgeons on-call. Sub-optimal practice includes variable antibiotic prescribing, unnecessary/prolonged hospitalisation, lack of ultrasound assessment/aspiration, frequent surgical drainage, inconsistent follow-up and significant diagnoses being missed. The objective was to evaluate management across a multi-site NHS Trust and address deficiencies with a ‘best-practice’ algorithm, encompassing National Institute for Health and Care Excellence (NICE) and Guidelines and Audit Implementation Network (GAIN) recommendations.

Introduction: The Guidelines and Audit Implementation Network (GAINS) guidelines (2009) for the management of breast abscess and mastitis, include the timing and choice of antibiotic therapy, use of ultrasound guided needle aspiration and need for specialist follow-up. A prospective audit in 2011 observed sub-optimal practice, non-uniform prescribing (6 different antibiotics), higher than anticipated rates of incision drainage (20%) and protracted length of stay (mean=2.21 days). Consequently, a ‘best practice’ proforma and treatment algorithm was developed in consultation with surgeons, radiologists, microbiologists and emergency physicians, and was adopted following quality and safety board review. The aim of this study was to demonstrate quality improvement.