Department of Speech Pathology and Audiology, Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Gold Coast, Southport, QLD, 4215, Australia.
Department of Physiotherapy, Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia.
BMC Pediatr. 2022 Nov 8;22(1):646. doi: 10.1186/s12887-022-03695-3.
Ear, Nose and Throat (ENT) primary contact models of care use audiologists as the first triage point for children referred to ENT for middle ear and hearing concerns; and have shown reduced waiting time, improved ENT surgical conversion rates and increased service capacity. This study aimed to investigate 'safety and quality' of the model by looking at agreement between audiologists' and an ENT's clinical decisions. METHODS: We performed an inter-rater agreement study on diagnosis and management decisions made by audiologists and an ENT for 50 children seen in an Australian hospital's ENT primary contact service, and examined the nature and patterns of disagreements.
Professionals agreed on at least one site-of-lesion diagnosis for all children (100%) and on the primary management for 74% (Gwet's AC1 = 0.67). Management disagreements clustered around i) providing 'watchful waiting' versus sooner medical opinion (18%), and ii) providing monitoring versus discharge for children with no current symptoms (8%). There were no cases where the audiologist recommended discharge when the ENT recommended further medical opinion.
Our novel research provides further evidence that Audiologist-led primary contact models for children with middle ear and hearing concerns are safe as well as efficient.
耳鼻喉（ENT）初级保健模式将听力学家作为儿童因中耳和听力问题转诊到 ENT 的第一个分诊点；并已显示出缩短了等待时间，提高了 ENT 手术转化率和增加了服务能力。本研究旨在通过研究听力学家和 ENT 之间的临床决策是否一致，来调查该模型的“安全性和质量”。
我们对在澳大利亚一家医院 ENT 初级保健服务中就诊的 50 名儿童的听力学家和 ENT 进行了诊断和管理决策的组内一致性研究，并检查了不一致的性质和模式。
专业人员对所有儿童的至少一个病变部位诊断达成一致（100%），对主要管理达成一致的比例为 74%（Gwet 的 AC1=0.67）。管理方面的分歧主要集中在：i）建议“观察等待”还是尽快获得医学意见（18%），以及 ii）对于没有当前症状的儿童，建议监测还是出院（8%）。没有听力学家建议出院而 ENT 建议进一步进行医学检查的情况。
我们的新研究进一步证明，对于中耳和听力问题的儿童，由听力学家主导的初级保健模式是安全有效的。
