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An innovative approach to improve ear, nose and throat surgical access for remote living Cape York Indigenous children.

Abstract On a background of high rates of severe otitis media (OM) with associated hearing loss, children from the Torres Strait and Cape York region requiring ear, nose and throat (ENT) surgery, faced waiting times exceeding three years. After numerous clinical safety incidents were raised, indicating a failure of the current system to deliver appropriate care, the governing Hospital and Health service opted to deliver surgical care through an alternate process. ENT surgeries were performed on 16 consented children from two remote locations via the private health care system, funded by a health provider partnership.
PMID
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Authors

Mayor MeshTerms
Keywords

Audiometry

Child

Chronic disease

Conductive/etiology

Hearing loss

Indigenous

Middle ear pathology

Otitis Media with Effusion/*therapy

Otitis media

Pure-tone

TeleHealth

TeleMedicine

Tympanoplasty

Journal Title international journal of pediatric otorhinolaryngology
Publication Year Start




PMID- 28802377
OWN - NLM
STAT- In-Process
DA  - 20170813
LR  - 20170813
IS  - 1872-8464 (Electronic)
IS  - 0165-5876 (Linking)
VI  - 100
DP  - 2017 Sep
TI  - An innovative approach to improve ear, nose and throat surgical access for remote
      living Cape York Indigenous children.
PG  - 225-231
LID - S0165-5876(17)30324-5 [pii]
LID - 10.1016/j.ijporl.2017.07.011 [doi]
AB  - INTRODUCTION: On a background of high rates of severe otitis media (OM) with
      associated hearing loss, children from the Torres Strait and Cape York region
      requiring ear, nose and throat (ENT) surgery, faced waiting times exceeding three
      years. After numerous clinical safety incidents were raised, indicating a failure
      of the current system to deliver appropriate care, the governing Hospital and
      Health service opted to deliver surgical care through an alternate process. ENT
      surgeries were performed on 16 consented children from two remote locations via
      the private health care system, funded by a health provider partnership. METHODS:
      We examined the collaboration processes alongside clinical findings from this ENT
      surgery. Collated patient data, included patient demographics, clinical and
      audiometry presentation features were reviewed and compared pre and
      post-operatively. Cost savings associated with the use of TeleHealth
      post-operatively were briefly examined. RESULTS: Surgeries were successfully
      completed in all 16 children. The reported mean waitlist time for ENT surgery was
      1.2 years. Pre-surgery pure-tone average hearing thresholds were reported at
      left: 30.9 dB, right: 38.2 dB. The majority of presentations were for bilateral
      OM with Effusion (69%). Post-surgical follow up indicated successful clinical
      outcomes in 80% of patients and successful hearing outcomes in 88% of patients.
      Mean difference pure-tone average hearing thresholds, left: 8.4 dB and right:
      11.2 dB. Furthermore, the majority of patients reported improved hearing and
      breathing. The use of TeleHealth for post-operative review enabled a minimum cost
      saving of AUD$21,664 for these 16 children. Overall, a high level of staffing
      resources was required to successfully coordinate this intense surgical activity.
      CONCLUSION: This innovative approach to a health system crisis enabled successful
      ENT surgical and hearing outcomes in 16 children, whose waitlisted time grossly
      exceeded state health recommendations. Using private health facilities funded by 
      a health partnership, while unlikely to be a suitable model of care for routine
      service delivery; may be applied as an adjunct service model when blockages and
      delays lead to sub-standard service provision. This approach may be applicable to
      other health care facilities when facing extended elective surgery wait times in 
      ENT or other specialty areas.
CI  - Copyright (c) 2017 Elsevier B.V. All rights reserved.
FAU - Jacups, Susan P
AU  - Jacups SP
AD  - Medical Services, Torres and Cape York Hospital and Health Service (TCHHS), Citi 
      Building Level 9 46-48 Sheridan Street, Cairns, QLD 4870, Australia; The Cairns
      Institute, James Cook University (JCU), Australia. Electronic address:
      [email protected]
FAU - Newman, Denise
AU  - Newman D
AD  - Medical Services, Torres and Cape York Hospital and Health Service (TCHHS), Citi 
      Building Level 9 46-48 Sheridan Street, Cairns, QLD 4870, Australia. Electronic
      address: [email protected]
FAU - Dean, Deborah
AU  - Dean D
AD  - Medical Services, Torres and Cape York Hospital and Health Service (TCHHS), Citi 
      Building Level 9 46-48 Sheridan Street, Cairns, QLD 4870, Australia. Electronic
      address: [email protected]
FAU - Richards, Ann
AU  - Richards A
AD  - Medical Services, Torres and Cape York Hospital and Health Service (TCHHS), Citi 
      Building Level 9 46-48 Sheridan Street, Cairns, QLD 4870, Australia. Electronic
      address: [email protected]
FAU - McConnon, Kate M
AU  - McConnon KM
AD  - Medical Services, Torres and Cape York Hospital and Health Service (TCHHS), Citi 
      Building Level 9 46-48 Sheridan Street, Cairns, QLD 4870, Australia; Institute of
      Health Innovation, Macquarie University, Australia. Electronic address:
      [email protected]
LA  - eng
PT  - Journal Article
DEP - 20170714
PL  - Ireland
TA  - Int J Pediatr Otorhinolaryngol
JT  - International journal of pediatric otorhinolaryngology
JID - 8003603
OTO - NOTNLM
OT  - Audiometry
OT  - Child
OT  - Chronic disease
OT  - Conductive/etiology
OT  - Hearing loss
OT  - Indigenous
OT  - Middle ear pathology
OT  - Otitis Media with Effusion/*therapy
OT  - Otitis media
OT  - Pure-tone
OT  - TeleHealth
OT  - TeleMedicine
OT  - Tympanoplasty
EDAT- 2017/08/15 06:00
MHDA- 2017/08/15 06:00
CRDT- 2017/08/14 06:00
PHST- 2017/05/15 [received]
PHST- 2017/07/11 [revised]
PHST- 2017/07/12 [accepted]
AID - S0165-5876(17)30324-5 [pii]
AID - 10.1016/j.ijporl.2017.07.011 [doi]
PST - ppublish
SO  - Int J Pediatr Otorhinolaryngol. 2017 Sep;100:225-231. doi:
      10.1016/j.ijporl.2017.07.011. Epub 2017 Jul 14.