Mors Matt, Bohr Colin, Fozo Michael, Shermetaro Carl
McLaren Oakland Regional Medical Center.
St. John Hospital and Medical Center.
Spartan Med Res J. 2020 Jan 30;4(2):11596. doi: 10.51894/001c.11596.
The purpose of this study was to evaluate the types of consultations received by an otolaryngology service at a 772-bed large metropolitan, MI-based hospital.
The authors performed a retrospective review of the specific types of consultations received during calendar year 2016.
A total of 518 consultations were reviewed and analyzed by the first and second authors (MM, CB). Consultations with low intervention rates included dysphagia (difficulty swallowing) (32.3%), dysphonia (difficulty speaking) (16%), otalgia (earache) (20.8%), hearing loss (13.3%), rule out vocal cord dysfunction (0%), and vertigo/dizziness (0%). Epistaxis (nosebleed) was the most frequent reason for consultations, and angioedema (lip or airway swelling) was the most common airway-related consultation. Notably, emergent or urgent surgery was only performed on 4.6% of sample patients. Several common consultation reasons (e.g., longer-term hearing loss evaluation and cerumen ("earwax") removal) could have been deferred for clinic-based evaluation where audiograms and microscopes are more readily available.
These findings suggest areas for continuing education for primary care provider and resident education to place more appropriate hospital consultations. Annual resident lectures to prepare junior residents for the most common call scenarios (i.e., control epistaxis and incision and drainage of peritonsillar abscesses) could be helpful in this area. In addition, didactic lectures for primary care physicians on how to evaluate patients with dysphagia may be of value as this was a common consult for otolaryngologist referrals.
本研究的目的是评估一家位于密歇根州的拥有772张床位的大型都市医院的耳鼻喉科所接收的会诊类型。
作者对2016日历年期间接收的特定会诊类型进行了回顾性研究。
第一作者和第二作者（MM，CB）共审查和分析了518例会诊。干预率较低的会诊包括吞咽困难（32.3%）、发音困难（16%）、耳痛（20.8%）、听力损失（13.3%）、排除声带功能障碍（0%）和眩晕/头晕（0%）。鼻出血是会诊最常见的原因，血管性水肿（嘴唇或气道肿胀）是最常见的与气道相关的会诊。值得注意的是，仅对4.6%的样本患者进行了急诊或紧急手术。一些常见的会诊原因（例如，长期听力损失评估和耵聍（“耳垢”）清除）本可以推迟到基于门诊的评估，因为那里更容易获得听力图和显微镜。
这些发现为初级保健提供者的继续教育和住院医师教育提出了建议，以便进行更合适的医院会诊。每年为住院医师举办讲座，让初级住院医师为最常见的呼叫场景（即控制鼻出血和扁桃体周围脓肿的切开引流）做好准备，在这方面可能会有所帮助。此外，为初级保健医生举办关于如何评估吞咽困难患者的教学讲座可能会有价值，因为这是耳鼻喉科医生转诊中常见的会诊。
