ENT Department, Royal National ENT and Eastman Dental Hospitals, London, UK.
UCLH Biomedical Research Centre Hearing Health Theme, London, UK.
Clin Otolaryngol. 2024 Sep;49(5):652-659. doi: 10.1111/coa.14192. Epub 2024 Jun 20.
Pathway innovation using smartphone otoscopy and tablet-based audiometry technologies to deliver ear and hearing services via trained audiologists may improve efficiency of the service. An ENT-integrated-community-ear service (ENTICES-combining community audiology management, remote ENT review and novel technologies) was piloted. We aimed to assess the efficiency and safety of ENTICES.
ENTICES was a community-based and audiologist-led pathway. Patients with otological symptoms were self-referred to this service. Smartphone otoscopy and tablet-based audiograms were performed. Two otologists reviewed all decisions made in the community by audiologists based on video-otoscopy, hearing tests and chart reviews. Data on the first 50 consecutive new patients attending either consultant-led hospital otology clinics (HOC), audiologist-led hospital advanced audiology diagnostics (AAD) or ENTICES clinics were collected between 1 August 2021 and 31 December 2021. Data were collected through chart reviews and questionnaires to compare the three pathways with respect to efficiency, patient satisfaction, technology utility and safety.
No audiology-led ENTICES decisions were amended by hospital otologists following remote review. Remote review of video-otoscopy with history was sufficient for a diagnosis in 80% of cases. Adding hearing tests and standardised history increased the diagnostic yield to 98%. Patient satisfaction scores showed 100% service recommendation. The cost per patient, per visit, was £83.36, £99.07 and £69.72 for AAD, HOC or ENTICES, respectively.
ENTICES provides a safe ear and hearing service that patients rated highly. Thirty-two per cent of hospital otology patients were eligible for this service. For those patients, ENTICES is 20% more cost-effective and can reduce the number of clinic visits by up to 60% compared with HOC.
利用智能手机耳镜和基于平板电脑的听力计技术，通过经过培训的听力学家为患者提供耳部和听力服务，从而改变服务模式，可能会提高服务效率。我们对一种耳鼻喉科-社区-耳科服务（ENTICES-结合社区听力学管理、远程耳鼻喉科审查和新技术）进行了试点研究。本研究旨在评估 ENTICES 的效率和安全性。
ENTICES 是一种基于社区和听力学家主导的途径。有耳部症状的患者可自行选择该服务。使用智能手机耳镜和基于平板电脑的听力图进行检查。两名耳鼻喉科医生根据视频耳镜检查、听力测试和图表审查，对社区中所有由听力学家做出的决策进行远程审查。于 2021 年 8 月 1 日至 2021 年 12 月 31 日，收集了 50 例连续就诊的新患者的数据，这些患者分别在顾问主导的医院耳科诊所（HOC）、听力学家主导的医院高级听力诊断（AAD）或 ENTICES 诊所就诊。通过图表审查和问卷调查收集数据，以比较三种途径在效率、患者满意度、技术实用性和安全性方面的差异。
远程审查时，没有听力学家主导的 ENTICES 决策被耳鼻喉科医生修改。在 80%的病例中，通过病史的视频耳镜远程审查即可做出诊断。如果增加听力测试和标准化病史，则诊断率可提高至 98%。患者满意度评分显示，100%的患者推荐该服务。每位患者每次就诊的费用分别为 AAD、HOC 或 ENTICES 就诊的 83.36 英镑、99.07 英镑和 69.72 英镑。
ENTICES 提供了一种安全的耳部和听力服务，患者满意度很高。32%的医院耳科患者符合该服务的条件。对于这些患者而言，与 HOC 相比，ENTICES 更具成本效益，可将就诊次数减少多达 60%。
