Advanced Audiologist- led Glue Ear Screening

Transcription

1 Poster Session HRT1317 Innovation Awards November 2013 Brisbane Advanced Audiologist- led Glue Ear Screening Pathway for paediatric ENT patients Presenter(s): Michelle Pokorny, Sally-Ann Schilt Logan Hospital, MetroSouth Hospital and Health Services

2 KEY PROBLEM - ENT Outpatient Wait Lists The ENT Outpatients Department at Logan Hospital is currently unable to provide services within reasonable timeframes for patients on the ENT Category 2 and Category 3 waiting list. The average waiting times for Category 2 adult ENT patients is 52 weeks, and there are no definitive timeframes within which a Category 3 patient will be seen. A new paediatric ENT OPD Service is to be provided within the current medical resources in the near future.

3 AIM OF THIS INNOVATION This innovation was the result of a Model of Care (MoC) project to develop an Advanced Allied Health Practitioner (AHP) Service for ENT Outpatients. The new Model of Care uses advanced Audiologists and Speech Pathologists as the point of first contact to improve eligible patients journeys and to reduce the ENT OPD wait list The MoC project included the development of pathways to improve services for adult ENT patients referred for vestibular dysfunction, dysphagia, dysphonia and retrocochlear pathology. The pathway with the greatest impact on wait list management however, is the Paediatric Glue Ear Pathway which this presentation will focus on. The aim of the Paediatric Glue Ear Pathway is: to assess and triage paediatric ENT patients more effectively to provide a more streamlined patient journey and to provide patients who do not require medical or surgical treatment with conservative management options and other diagnostic services in a more timely and efficient manner.

4 BASELINE DATA The ENT paediatric wait list opened up in January A wait list audit was conducted in February 2013 at the commencement of the Model of Care project. Paediatric ENT Referrals by Primary Complaint (February 2013) Current Situation (October 2013) Category 2 Category 3 Total Number of referrals Ear related 61 (67%) 22 (14%) 83 (34%) Complex ear 17 (19%) 12 (8%) 29 (13%) Routine ME disease and/or hearing 44 (48%) 10 (6.5%) 54 (24%) Post-op grommet s categorisation based on operation notes (March 2013) Complex Routine Post-op grommet s 37.5% 62.5% 324 New paediatric patients have been seen in ENT OPD since January But the ENT paediatric wait list has grown to 583 referrals on the Cat 2 and Cat 3 wait lists 61% of Cat 2 paediatric referrals are now waiting longer than 90 days 69% of Cat 3 paediatric referrals are now waiting over 90 days. In addition the adult ENT Wait List has grown to 2,982 patients with 45% of Cat 2 patients and 60% of Cat 3 patients now waiting over 12 months.

5 KEY CHANGES IMPLEMENTED Paediatric ENT Wait List (Glue Ear or Hearing) A clinical pilot was undertaken in March- May 2013 to test the concept of a new Model of Care pathway for paediatric ENT patients. ENT Assessment ENT pre-admit clinic Grommet surgery Traditional Mode el of Care Pre-ENT AHP Assessment (Audiologist-led) ENT pre-admit clinic Grommet surgery Post op grommet AHP Review clinic (Audiologist-led) New Model of Ca are Eligibility criteria: Children referred to ENT with non-complex middle ear disease and/or hearing related symptoms and children undergoing routine grommet insertion. Protocol: Evidence-based and utilising advanced scopes of practice for Audiologists. Training: Training packages have been developed to provide advanced level knowledge for Audiologists to provide this service. Standardisation of patient management: Patient discharge or referral for ENT is based on an evidence-based clinical guideline and from overseas Models. Standardisation of patient information: Patients receive written and verbal information on post-grommet care and complications. Routine cases discharged to GP care

6 OUTCOMES SO FAR The Glue Ear Pathway Clinical Pilot was conducted during March- May 2013 Outcomes: 48% of Cat2 paediatric ENT referrals were eligible to be seen in the new MoC pathway 50% of eligible new patients were discharged without requiring an ENT consultation. 35% of eligible new patients seen in the pre-ent clinic were referred directly to ENT to discuss surgical options 63.5% of grommet insertions were categorised as routine and able to be seen in the Audiologist-led post-op grommet clinics. 73% of routine post-op grommet s were able to be discharged to GP care without requiring a separate ENT consultation. Evaluation: The pilot was evaluated using activity data, patient satisfaction, stakeholder interviews, issues and complications logs and an audit of the proposed clinical pathway. Patient satisfaction as measured through a Patient Satisfaction Questionnaire, and Stakeholder views were universally positive for both the pre-ent and Post grommet clinics. Funding was approved to implement the new MoC to commence in October The impact of the MoC project has resulted in an increased interest within the Audiology profession to work towards developing skills in Advanced Scopes of Practice.

7 LESSONS LEARNT The support of key Medical stakeholders is paramount. Other Keys to success: Strict entry criteria. Clear protocols and referral pathways and guidelines Evidence from the literature and other international models There is limited amount of published research on discipline-specific new Models of Care. New services should commit to contribute to growing this body of literature. Administrative support is essential for any new clinical service to provide efficient service delivery. Training packages are required to develop skills in areas of advanced scope of practice. Challenges: Sustainability of the service with staffing changes