ENT Department, Royal National Throat Nose and Ear Hospital, London, UK.
evidENT Ucl Ear Institute, University College London, London, UK.
BMJ Open Qual. 2022 Feb;11(1). doi: 10.1136/bmjoq-2021-001444.
The COVID-19 pandemic has catalysed the need to implement the National Health Service Long-Term Plan to deliver more care in the community and to reduce face-to-face hospital appointments by up to 33%. This study aimed to assess the feasibility of a remote otology service from triage through to delivery.
New adult otology referrals at a tertiary ear, nose and throat (ENT) hospital aged between 18 and 70 with hearing loss or tinnitus were included. Patients attended an audiology-led community clinic where they underwent a focused history, audiometric testing, and a smartphone-based application and otoscope (Tympa System) was used to capture still and video images of their eardrums. The information was reviewed by ENT clinicians using a remote review platform with a subset of patients subsequently undergoing an in-person review to measure concordance between the two assessments.
58 patients participated. 75% of patients had their pathways shortened by one hospital visit with 65% avoiding any hospital attendances. 24% required an additional face-to-face appointment due to incomplete views of the tympanic membrane or need for additional examinations. Electronic validation by a blinded consultant otologist demonstrated a diagnosis concordance of 95%, and concordance between remote-review and in-person consultations in the 12 patients who agreed to attend for an in-person review was 83.3%. 98% of patients were satisfied with the pathway.
This pilot service is feasible, safe and non-inferior to the traditional outpatient model in the included patient group. There is potential for the development of a community audiology-led service or use for general practioner advice and guidance.
COVID-19 大流行促使人们需要实施国民保健服务长期计划，以便在社区提供更多的护理，并将面对面的医院预约减少多达 33%。本研究旨在评估从分诊到提供远程耳科学服务的可行性。
在一家三级耳鼻喉科（ENT）医院，纳入年龄在 18 至 70 岁之间、有听力损失或耳鸣的新成年耳科学转诊患者。患者参加了由听力学家主导的社区诊所，在那里他们接受了重点病史、听力测试以及使用智能手机应用程序和耳镜（Tympa 系统）拍摄他们鼓膜的静态和视频图像。ENT 临床医生使用远程审查平台审查这些信息，部分患者随后进行了面对面的审查，以衡量两种评估之间的一致性。
58 名患者参与了该研究。75%的患者就诊路径缩短了一次医院就诊，65%的患者避免了任何医院就诊。24%的患者因鼓膜视图不完整或需要额外检查而需要额外的面对面预约。由盲法顾问耳科医生进行的电子验证显示诊断一致性为 95%，在同意进行面对面审查的 12 名患者中，远程审查和面对面审查之间的一致性为 83.3%。98%的患者对该途径表示满意。
该试点服务是可行的、安全的，在纳入的患者群体中与传统的门诊模式无差异。有可能开发社区听力学家主导的服务，或用于全科医生的咨询和指导。
