Delivery of remote otology care: a UK pilot feasibility study

BMJ Open Qual. 2022 Feb;11(1):e001444. doi: 10.1136/bmjoq-2021-001444.

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: COVID-19; outpatients; quality improvement; telemedicine; waiting lists.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • COVID-19*
  • Feasibility Studies
  • Humans
  • Middle Aged
  • Otolaryngology*
  • Pandemics
  • SARS-CoV-2
  • State Medicine
  • United Kingdom
  • Young Adult