School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia Campus, Brisbane, Queensland, Australia.
Logan Hospital Integrated Specialist ENT Service, Metro South Health Service District, Queensland Health, Brisbane, Queensland, Australia.
Ear Hear. 2020 Sep/Oct;41(5):1103-1110. doi: 10.1097/AUD.0000000000000855.
Expansion of the scopes of practice of allied health practitioners has the potential to improve the efficiency and cost-effectiveness of healthcare, given the identified shortages in medical personnel. Despite numerous examples in other allied health disciplines, this has yet to be applied to pediatric Audiology. This study aimed to investigate the effectiveness and safety of using audiologists with advanced training to independently triage children referred to otolaryngology (ORL) services, and compare the subsequent use of specialist resources, and postoperative grommet care to a standard medical ORL service.
One hundred twenty children consecutively referred to a large ORL outpatient service in Queensland, Australia, for middle ear and hearing concerns were prospectively allocated to either the ORL service or Advanced Audiology-led service. Demographic and clinical data were extracted from electronic medical records and compared between the two services. Clinical incidents and adverse events were recorded for the Advanced Audiology-led service.
Approximately half of all children referred to ORL for middle ear or hearing concerns were discharged without requiring any treatment, with the remaining half offered surgical treatment. The Advanced Audiology-led model increased the proportion of children assessed by ORL that proceeded to surgery from 57% to 82% compared with the standard medical ORL model. Children followed up by the audiologists after grommet insertion were more likely to be discharged independently and at the first postoperative review appointment compared with the standard medical ORL service. There were no reports of adverse events or long-term bilateral hearing loss after discharge by the Advanced Audiology-led service.
These findings indicate that an Advanced Audiology-led service provides a safe and effective triaging model for the independent management of children not requiring treatment, and children requiring routine postoperative grommet review, and improves the effective use of specialist resource compared with the standard medical ORL service.
鉴于医务人员短缺，扩大医疗保健相关从业人员的执业范围可能提高医疗保健的效率和成本效益。尽管在其他医疗保健学科中有许多这方面的例子，但这尚未应用于儿科听力学。本研究旨在调查使用接受过高级培训的听力学家独立对转介到耳鼻喉科（ORL）服务的儿童进行分诊的效果和安全性，并比较随后对专科资源的使用以及与标准医疗 ORL 服务相比，术后鼓膜切开术护理的效果。
120 名连续转介到澳大利亚昆士兰州一家大型耳鼻喉科门诊服务的患有中耳和听力问题的儿童前瞻性地分配到 ORL 服务或高级听力主导服务。从电子病历中提取人口统计学和临床数据，并比较两种服务。记录高级听力主导服务中的临床事件和不良事件。
大约一半转介到 ORL 就诊的儿童因中耳或听力问题而无需接受任何治疗即可出院，另一半则接受手术治疗。与标准医疗 ORL 模型相比，高级听力主导模型将接受 ORL 评估的儿童中进行手术的比例从 57%增加到 82%。与标准医疗 ORL 服务相比，接受鼓膜切开术后由听力学家随访的儿童更有可能在独立和第一次术后随访时出院。高级听力主导服务出院后没有报告不良事件或长期双侧听力损失。
这些发现表明，高级听力主导服务为不需要治疗的儿童以及需要常规术后鼓膜切开术复查的儿童提供了一种安全有效的分诊模式，并与标准医疗 ORL 服务相比，提高了专科资源的有效利用。
