Rapid implementation of an evidence‐based remote triaging system for assessment of suspected referrals and patients with head and neck cancer on follow‐up after treatment during the <scp>COVID</scp>‐19 pandemic: Model for international collaboration

Paleri, Vinidh; Hardman, John; Tikka, Theofano; Bradley, Paula T.; Pracy, Paul; Kerawala, Cyrus

doi:10.1002/hed.26219

Cited by 49 publications

(50 citation statements)

References 19 publications

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“…One such innovation is the use of a remote evidence‐based triage system (Paleri et al . 2020) to stratify patients according to likely risk of cancer. Patients with voice and swallowing symptoms, which are least likely to be attributable to a cancer diagnosis, could potentially be directed toward SLT‐led clinics (see voice services below).…”

Section: Service Delivery/clinical Implicationsmentioning

confidence: 99%

“…Notably, the newly proposed remote evidence‐based triage system described above (Paleri et al . 2020) could further increase referrals for SLT‐led EEL clinics. An ENT SLT‐led Two Week Wait HNC referral pathway for low risk hoarse patients pilot study demonstrated an excellent safety record for cancer screening and more efficient access to voice services (Slade and McGlashan 2019).…”

Section: Service Delivery/clinical Implicationsmentioning

confidence: 99%

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COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

Patterson

Govender

Roe

et al. 2020

Intl J Lang & Comm Disor

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Background The COVID‐19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high‐risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. Aims To discuss the threats and opportunities from the COVID‐19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. Methods & Procedures The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple‐group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. Main Contribution The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID‐19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non‐instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face‐to‐face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge. Conclusions & Implications The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post‐COVID era to re‐evaluate current practice, embrace opportunities and evaluate new ways of working.

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Section: Service Delivery/clinical Implicationsmentioning

confidence: 99%

Section: Service Delivery/clinical Implicationsmentioning

confidence: 99%

COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

Patterson

Govender

Roe

et al. 2020

Intl J Lang & Comm Disor

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“…The survey responses did not account for the number of clinics that could run simultaneously, so the estimated reduction in patient numbers is not likely to represent the full extent of the ongoing backlog. It is, therefore, important that strategies are developed to address limited space in outpatient clinics [13].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and the return to head and neck outpatient activity in the United Kingdom: what is the new normal?

Bola

Jaikaransingh

Winter

2020

Eur Arch Otorhinolaryngol

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Purpose As surgical specialties now begin the graduated return to elective activity and face-to-face clinics, this paper investigates the current head and neck outpatient practices across the United Kingdom. Methods A cross-sectional study comprised of an online 20-item survey was distributed to members of the British Association of Head & Neck Oncologists (BAHNO). The survey was open on a web-based platform and covered topics including safety measures for patients, protective equipment for healthcare staff and protocols for the use of flexible nasendoscopy in the clinic. Results The survey was completed by 117 participants covering 66 NHS Trusts across the UK. There was a significant reduction in face-to-face Otolaryngology, Maxillofacial and Speech and Language clinic patients when compared to pre-pandemic numbers (p < 0.0001). Risk assessments for flexible nasendoscopy were done for 69% of clinics and 58% had an established protocol. Room downtime after flexible nasendoscopy ranged from 0 to 6 h and there was a significant increase in allocated downtime after a patient had coughed/sneezed (p < 0.001). Natural ventilation existed in 36% of clinics and the majority of responders didn’t know the Air Change Per Hour (ACPH) of the clinic room (77%). Where ACPH was known, it often did not match the allocated room downtime. Conclusion There is a wide variation in outpatient activity across the United Kingdom, but adaptations are being made to try and maintain staff and patient safety. However, more can still be done by liaising with allied teams to clarify outpatient protocols.

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“…During the pandemic there has been a significant number of guidelines produced by international sources, UK governmental organisations as well as specialist bodies such as the Royal Colleges and specialist organisations [4][5][6][12][13][14][15][16][17] . These guidelines have dealt with a number of aspects including personal protective equipment, prioritisation of treatment and recovery.…”

Section: Introductionmentioning

confidence: 99%

“…These guidelines have dealt with a number of aspects including personal protective equipment, prioritisation of treatment and recovery. As well as specific aspects of Otolaryngology practice, including cancer, clinics, tracheostomy, rhinology, otology and paediatrics [4][5][6][12][13][14][15][16][17] .…”

Section: Introductionmentioning

confidence: 99%

Timing and volume of information relevant to the Otolaryngologist during the COVID-19 pandemic in the UK.

Cernei

Shrivastava

Flannery

et al. 2020

Preprint

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Background: The SARS-CoV-2 was first reported in December 2019 in Wuhan, China and has been declared a pandemic in March 2020. COVID-19 has caused unprecedented and lasting biopsychosocial effects worldwide. All healthcare professionals have faced life threatening risks by attending their daily jobs. The daily emergence of advice and guidelines was necessary to ensure the safety of patients and staff. To this effect, all elective services came to a halt to preserve hospitals' capacity for dealing with the sickest. This retrospective, descriptive review aims to assess the volume and timing of the advice released specifically relevant to the UK Otolaryngologist. Methods: The search included online advice published in English by international, national and ENT-specific organisations between the 1st of January to the 31st of May. The date, title, source, type of advice and link to the advice was recorded in Excel. The resources were analysed per week of publication. A separate search for peer-reviewed publications was conducted using PubMed Central and Cochrane databases. Findings: 175 covid-19 related guidance's were identified. 52/175 (29.7%) articles were published by international organisations. 56/175 (32%) were produced by national organisations and 67/175 (38.28%) were produced by ENT specific organisations. The peak guidance production took place in the third and fourth week of March (16/03/2020-29/03/2020) with 72/175 publications. Of these, 27/72 came from the international category, 17/72 from national bodies and 28/72 from ENT-specific organisations. 13,863 total publications relating to COVID-19 were found using PubMed and Cochrane search strategies; 76% were relevant to ENT surgeons. Conclusion: The challenges faced by the Otolaryngologist relate to the unprecedented, sudden and daily changes to clinical practice. Multiple bodies interpreted the guidance giving an opportunity for confusion and delays in treatments for patients. Implementing a system with clear lines of communication and dissemination of information will improve our response in future pandemic events whilst maintaining a commercial awareness to better use the human and financial resources of an already financially-restricted NHS.

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Rapid implementation of an evidence‐based remote triaging system for assessment of suspected referrals and patients with head and neck cancer on follow‐up after treatment during the COVID‐19 pandemic: Model for international collaboration

Cited by 49 publications

References 19 publications

COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

COVID-19 and the return to head and neck outpatient activity in the United Kingdom: what is the new normal?

Timing and volume of information relevant to the Otolaryngologist during the COVID-19 pandemic in the UK.

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