The new multidisciplinary guideline has been finalised and approved for practice and future auditing.

Tonsillectomy is one of the commonest ENT paediatric procedures. Recovery is best achieved at home, and cost-effectiveness of the day case pathway is significant in tonsillectomy. This project scrutinised the local practice regarding the effectiveness of day case pathway in paediatric tonsillectomy in a large regional teaching hospital. The project aimed to improve the rates of day case tonsillectomy discharges, to increase compliance of postoperative care with guidelines, and to assess long-term sustainability of the new practice. The project looked prospectively at the pre-existing paediatric tonsillectomy day case practice (cycle 1) prior to implementing a multifaceted intervention. The intervention consisted of an evidence-based change to local day case tonsillectomy guidelines, improved lists' planning/management, and clinicians' education. Thereafter, the outcomes were measured in the short term (cycle 2-prospective data collection) and in the long term (cycle 3-retrospective data collection). The gathered data revealed an improvement in post-tonsillectomy day case discharge rates (both short and long term), without an increase in postoperative complications. Moreover, our intervention had effectively reduced sleep study requests and resulted in a significant increase in list profitability.Conclusion: The departmental practice in paediatric day case tonsillectomy was improved via evidence-based relaxation of day case criteria, improved list management, and clinicians' education. The interventions resulted also in a positive significant financial impact with no increase in postoperative complications. What is Known: • Tonsillectomy is a common paediatric ENT procedure, with significant applicability and cost-effectiveness of the day case pathway. • There is a lack of a clear general consensus on criteria for patients' suitability for day case tonsillectomy. What is New: • This quality improvement project carried out a methodical relaxation of day case criteria of day case tonsillectomy. • The new criteria along with enhanced list management and clinician education had safely improved the local post-tonsillectomy day case care.

Background:  Continuous clinical audit tools are important in the maintenance of good medical practice and will doubtlessly be used for revalidation purposes. Accordingly, ENT.UK and BRS developed The Rhinology Minimum Electronic Dataset, which is completed via online submission of pre‐ and postoperative SNOT22 scores of patients visiting the outpatient department. According the web tool guidance notes, once familiar with the system, any data entry relating to a single patient should take between 30 and 60 s. It also advises entering data in real time rather than at a later date to save time. Aim:  This study assesses the resource requirements for submitting patients’ SNOT22 data using the Rhinology Minimum Electronic Dataset web tool. Method:  SNOT22 scores were collected over a week of ENT outpatient sessions in April 2011. The number of patients (n) was 31. The data were submitted in a single sitting for each OPD session to avoid delays arising from automatic website logout. The study was carried out using a fast Internet connection (20 Mb) and an advanced computer operating system (Windows 7®, Intel core i3), compared with those available locally. Results:  The number of SNOT 22 scores collected was 31. The total submission time for SNOT22 results was 125 min, with an average time of 4 min per single patient’s data. The automatic logout time for the website was 20 min. Discussion:  Our results show that the time required to enter patients’ data to the website is far longer (300% delay per patient) than the time suggested by the guidance notes. This would be even longer in real time using clinic‐based computers and Internet connection. The study suggests that the best results would be achieved by entering patients’ data at one sitting, rather than individually, following every OPD session, as a result of automatic logout time of the web browser. If our rhinology service were to use the web tool to register patients’ data, it would have a significant impact on our service resource and OPD consultation time.

Orbital infections are regularly encountered and are managed by various healthcare disciplines. Sepsis of the orbit and adjacent tissues can be associated with considerable acute complication and long term sequelae. Therefore, prompt recognition and management of this condition are crucial. This article presents the outcomes of a 7-year complete cycle audit project and describes the development of the new local guideline on the management of orbital infections in our tertiary centre. Methods:1. A retrospective 5-year audit cycle on patients with orbital infections 2. A review of available evidence on the management of orbital infections A new local multidisciplinary guideline on the management of orbital infections A retrospective 2-year second audit cycle to assess the clinical outcomes Results:Various disciplines intersect in the management of orbital infections. Standardising the management of this condition proved to be achievable through the developed guideline.However, room for improvement in practice exists in areas such as the promptness in referring patients to specialist care, the multidisciplinary assessment of patients on admission, and the improvement of scanning requests of patients.

As a recognised cause of acute stroke, particularly in younger patients, spontaneous carotid artery dissection is an important diagnosis to consider. Although advances in interventional radiology are improving diagnosis, it is still considered an underrecognised phenomenon [1]. It is estimated to account for around 2.5% of all strokes, but this figure is much higher for younger patients [2]. However, the clinical presentation can be varied, subtle and often challenging to make, with multiple different presentations described. Unilateral cranial nerve palsies, particularly of the lower cranial nerves, are a recognised sign in up to 12% of cervical artery dissections [1], and it is therefore vital to be able to recognise them. We present a case of a man referred to a head and neck cancer clinic with unilateral lower cranial neuropathies and neck pain who was subsequently found to have an internal carotid artery dissection.

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Background: Pleomorphic salivary adenomas (PSA) are the commonest salivary tumor and are benign neoplasms that affect mostly the parotid glands. PSA's can however affect the minor salivary glands, typically around the palate. The treatment of choice for minor gland PSA's is via complete surgical excision and close monitoring to exclude recurrences. Case Report: We describe here a rare case of a minor salivary gland pleomorphic adenoma arising from the glosso-tonsillar sulcus in a 41-year-old patient. The presented tumor was treated with full surgical excision and was followed-up with regular MRI scans to rule out recurrences. Conclusion: PSA's of the minor salivary glands are uncommon and should be treated with a high level of suspicion due to a high malignant potential.