On the minimum requirements for otolaryngology clinics in nhs hospitals Report by the Clinical Governance & Audit Committee of the Scottish Otolaryngological Society (ent scotland) March 2014



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On the minimum requirements for otolaryngology clinics in NHS hospitals

Report by the Clinical Governance & Audit Committee of the Scottish Otolaryngological Society (ENT Scotland) March 2014.

Musheer Hussain (Chair) David Baring (Lothian) Angus Cain (Highland) Andrew Clement (Glasgow & Clyde) John Dempster (Ayrshire) Kerry Haddow (Fife) Stephen Jones (Tayside) Balaji Natarajan (Lanarkshire) Bhasker Ram (Grampian) Saghir Sheikh (Glasgow & Clyde) Aileen White (Glasgow & Clyde)

The design of an out-patients department is well documented1as are the building requirements for ENT, audiology and hearing aid clinics2. The minimal requirements for equipment and associated matters that allow the proper functioning of an ENT outpatient department was published by ENT UK in 19933 and a document on decontamination and sterilization of rigid and flexible endoscopes was published in 20104.

There have been significant changes in practice in the use of equipment since so that the Clinical Governance & Audit Committee (CGAC) was asked to produce a report on the updated minimal requirements for Otolaryngology clinics in NHS hospitals.

This report is the result of a consultative process between the members of the CGAC and will be presented to the Council and membership of the society.

The main functions of an Outpatients department are1



  1. Specialist consultation and examination

  2. Treatment of patients who do not require the facilities of either an acute day patient or in-patient ward

  3. Screening for the selection of patients for day case treatment, day surgery or in-patient procedures

  4. Pre-operative assessment

  5. Following up and monitoring the condition of patients after day case treatment, day surgery or in-patient procedures

  6. Discharging patients from the care of the hospital, with referral if necessary to other health service providers

  7. Counseling patients and carers

  8. Additionally, the OPD may provide an assessment and treatment facility in the event of a major disaster

One long standing problem has been the difference in the standard of equipment available in some peripheral hospitals/clinics both in urban and remote and rural areas compared to the main hospitals. Colleagues have previously shown5 that the provision of adequate clinic equipment have medium to long term economic advantages and also has relevance in relation to clinical governance and potential medico-legal concerns, as significant numbers of patients have to be reviewed elsewhere when equipment is inadequate in the peripheral clinic. We seek uniformity in standards so that patients are not disadvantaged.

The other important point to make is that there has been an increase in use of outpatients for ENT procedures as the specialty lends itself to office based practice and only 10-12 percent of patients require hospital admission for procedures. As an example in Tayside 10,800 procedures were performed in the out patients in 2013.

The agreed list of essential (minimal) and desirable requirements are as follows:


Essential Desirable

LARYNGOLOGY / HEAD & NECK






Flexible Naso-laryngoscopy equipment (in sufficient numbers|)

Head light

Tongue depressors

FNA Equipment

True-cut biopsy equipment


Flexible video-rhino-laryngoscope (also known as HD Chip in Tip Endoscope)







VOICE CLINIC




Flexible Nasolaryngoscope with stroboscopy, and video capture.

Rigid Laryngoscope for voice assessment



Flexible video-rhino-laryngoscope (also known as HD Chip in Tip Endoscope)







RHINOLOGY /FPS




Rigid nasal endoscopy (in sufficient numbers)

Nasal speculae

Biopsy instruments

Cautery equipment

Nasal packs and associated equipment

Endoscope cameras and access to medical photography



HD Endoscope camera

Facilities for inhalant allergy assessment

Equipment for physical airway measurement

Facility for skin prick tests for allergy









OTOLOGY




Otoscopes

Microscope and otoendoscopes

Aural speculae

Suction and other aural instruments

Tuning forks


Fine middle ear instruments tray







Photo / video documentation




Endoscopic / microscopic images

External images by digital camera or medical photography

Printer for still images in medical records  


Flexible video-rhino-laryngoscope Video recording equipment








CLINIC AREA




Examination couch
Hand wash basin

Decontamination & sterilisation facilities to national standards

Patient information leaflets and clinic wait time display board
Human Resources: Adequate numbers of nurses (1 per clinic room) and audiologists

Availability of drugs commonly used in OP




Adjustable dental type chair

Sound proof booth to British standard
Regularly calibrated audiometer for pure tone audiometry and tympanometer equipment
Vestibular assessment facilities for Vestibular clinic

Speech audiometry

Computer in each clinic room with internet and printer access



Acknowledgement: I would like to thank Mr Peter Ross and Dr Mary-Louise Montague for their help.


References

  1. Health Building Note 12 (HBN12) DOH guidance on the design of an out-patients department that is attached to, or forms part of, an acute hospital or treatment centre. 1990 NHS Leeds




  1. HEALTH BUILDING NOTE 12 SUPPLEMENT 3 Out-patients department Supplement 3 - ENT and audiology clinics, hearing aid centres 1994 Amended NHS Wales 2013

  2. Minimum requirements for otolaryngology departments in NHS hospitals. The British Association of Otolaryngologists, London 1993

  3. Guidance on the decontamination and sterilization of rigid and flexible endoscopes ENT UK 2010 https://entuk.org/professionals/publications Accessed March 2014



  1. Cain AJ, Laing MR A review of otolaryngology equipment provision in a peripheral clinic setting. Health Bull (Edin). 2000 Nov;58(6):467-70


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