Deptment of ENT-Head & Neck Surgery, London North West University Healthcare NHS Trust, London, Harrow, HA1 3UJ, UK.
School of Public Health, San Diego State University, San Diego, CA, USA.
BMC Health Serv Res. 2022 May 9;22(1):625. doi: 10.1186/s12913-021-07416-x.
Flexible nasendoscopy (FNE) is an invaluable multi-disciplinary tool for upper aerodigestive tract (UADT) examination. During the COVID-19 pandemic concerns were raised that FNE had the potential of generating aerosols resulting in human cross-contamination when performed on SARS-COV2 carriers. In the UK, and other European countries, national guidelines were issued restricting FNE to essential cases. We surveyed ENT-UK members and Royal College of Speech and Language Therapists (RCSLT) members to determine the impact of the COVID-19 pandemic (first peak) on FNE practice in the UK.
An observational internet-based survey constructed in accordance to the CHERRIES checklist and setup in SurveyMonkey of FNE practice amongst UK-based ENT surgeons and speech and language therapists in community clinics, the outpatient department, inpatient wards, ICU, emergency department and operating theatres (through the NHS and private sector) prior to, during and following the first COVID-19 wave in the UK.
314 responses collected (24% response rate), 82% from ENT clinicians, 17% from SLTs and 1% from other allied healthcare professionals. Overall, there has been a large reduction in the volume and indications for FNE during the first peak of the COVID-19 pandemic with limited recovery by mid-August 2020. Cancer and airway assessments were impacted less. A wide range of FNE protocols influenced by local factors are reported, varying in endoscope preference, Personal Protective Equipment (PPE) and sterilization methods. Where dedicated Aerosol Generating Procedure (AGP) rooms were unavailable, clinicians resorted to window opening and variable room "down-time" between patients. Endoscope preference reflected availability and user familiarity, ENT trainees favoring the use of single-use video endoscopes.
Despite national guidance, local practice of FNE remains interrupted and highly variable in the UK. A collaborative inter-disciplinary approach is required to re-introduce FNE safely in volume across healthcare settings, re-establishing timely endoscopic diagnosis and pre-pandemic levels of patient care.
灵活鼻内镜检查（FNE）是上呼吸道（UADT）检查的一种非常宝贵的多学科工具。在 COVID-19 大流行期间，人们担心 FNE 在对 SARS-COV2 携带者进行检查时有可能产生气溶胶，从而导致人与人之间的交叉污染。在英国和其他欧洲国家，发布了国家指南，限制 FNE 用于必要的情况。我们对 ENT-UK 成员和英国皇家言语治疗师学院（RCSLT）成员进行了调查，以确定 COVID-19 大流行（第一波）对英国 FNE 实践的影响。
根据 CHERRIES 清单构建的基于互联网的观察性调查，并在 SurveyMonkey 中设置了在英国进行的 ENT 外科医生和言语治疗师在社区诊所、门诊部、住院病房、重症监护病房、急诊科和手术室（通过 NHS 和私营部门）进行 FNE 实践的调查，在此之前、期间和之后在英国的第一波 COVID-19 期间。
共收集了 314 份回复（24%的回复率），82%来自 ENT 临床医生，17%来自言语治疗师，1%来自其他联合医疗保健专业人员。总体而言，在 COVID-19 大流行的第一波期间，FNE 的数量和适应症大幅减少，到 2020 年 8 月中旬才有所恢复。癌症和气道评估的影响较小。报告了广泛的受当地因素影响的 FNE 方案，包括内窥镜偏好、个人防护设备（PPE）和消毒方法。在没有专用的气溶胶生成程序（AGP）室的地方，临床医生则选择打开窗户，并在患者之间留出可变的房间“停机”时间。内窥镜偏好反映了可用性和用户熟悉程度，ENT 受训者倾向于使用一次性使用的视频内窥镜。
尽管有国家指导，但英国的 FNE 实践仍中断且高度多样化。需要采取跨学科的协作方法，在整个医疗保健环境中安全地重新引入 FNE，以恢复及时的内镜诊断和大流行前的患者护理水平。
