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\title{Improving clinical practice in ENT: lessons learnt from the COVID-19
pandemic}



\author[1]{James Tysome}%
\affil[1]{Cambridge University Hospitals}%


\vspace{-1em}



  
  \date{May 05, 2024}


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Improving clinical practice in ENT: lessons learnt from the COVID-19
pandemic

James R Tysome, Cambridge University Hospitals, UK

Editor-in-Chief, Clinical Otolaryngology

While currently in the midst of another wave of COVID-19 infections,
putting untold strain on both healthcare systems and healthcare workers
around the globe, it is important to reflect on the changes that we have
all had to make. All ENT departments, within a very short timeframe,
restructured clinical services to prioritise the delivery of patient
care to those with the greatest clinical need, while increasing services
such as tracheostomy for the high number of patients with COVID-19 in
intensive care. We also changed the methods that we use to teach our
trainees and share knowledge with colleagues. Many of these changes have
been successful and should now be maintained in the future.

It has been fascinating to see the how the research community built new
research networks and redirected focus to projects related to
understanding SARS-CoV-2 infection; surveillance and public health
measures, optimising patient management of the disease and understanding
the impact of COVID-19 on different healthcare systems. This resulted in
over 89,000 peer reviewed publications relating to COVID-19 in 2020 and
the development of new research structures such as \emph{CovidSurg} , a
global collaborative platform of studies aiming to explore the impact of
COVID-19 on surgical patients.\textsuperscript{1}

Two papers in this issue demonstrate how clinical practice in ENT
adapted to COVID-19. The first explores the publication of guidance
relevant to ENT.\textsuperscript{2} Both national bodies and specialist
societies across the globe published guidance on how services should be
reconfigured, patients prioritised, and ENT surgeons protected,
particularly with respect to aerosol generating procedures given the
potential high risk of infection. It is the speed of publication that
was particularly impressive. Of the 175 online publications of COVID
guidance related to ENT, 41\% were published between the third and
fourth week of March 2020.

The second study explores the impact of this guidance on clinical care
through a prospective audit of the management of tonsillitis and
peritonsillar abscess in 86 hospitals across the UK following the
publication of guidelines by ENT UK, the professional body representing
ENT surgeons in the UK. This provided a pathway that aimed to prevent
hospital admission when safe to do so.\textsuperscript{3} Increased use
of single doses of intravenous dexamethasone and antibiotics resulted in
return to swallowing in many patients, allowing patients to be
discharged safely, without later increases in re-presentation or
admission.

These studies show the strong clinical leadership has been demonstrated
within the ENT community, removing traditional barriers to change.
Clinicians have taken the initiative to develop new pathways and new
ways of working. An almost overnight change from face-to-face
appointments to remote appointments took place in many hospitals,
showing how we can adapt when needed. Remote appointments, either by
telephone\textsuperscript{4} or video calls,\textsuperscript{5} are
suitable for many ENT patients, preferred by many and are certainly here
to stay.

There has been rapid scaling of technology such as digital consultation
platforms to enable this remote service delivery. Video conferencing
facilitates multidisciplinary team meetings, bringing together
clinicians at distant locations to discuss patient management in an
efficient manner without the need to spend hours travelling to meet in
the same location. Virtual patient consultations can allow sharing of
digital information such as imaging without the patient needing to leave
their home, reduced footfall in previously over-crowded outpatient
departments.

New teaching and training opportunities have arisen through the use of
digital conferencing platforms, replacing traditional teaching
programmes and allowing us to reach larger
audiences.\textsuperscript{6}Entire conferences have successfully moved
to virtual participation. These opportunities have the potential to
significantly enrich training and teaching in the future.

We have seen many examples of enhanced local system working. ENT and
intensive care teams have needed to work more closely together to manage
patients with COVID-19 requiring a tracheostomy.\textsuperscript{7} It
is important that these closer relationships are maintained in the
future for patient benefit.

The ENT community has demonstrated strong clinical leadership,
adaptability to rapid change, enhanced clinical pathways and local
networks, widespread use of digital technology for consultation and
teaching and redirection of research programmes. These have permanently
changed the way we work and, when the current global pandemic improves
as COVID-19 infections drop and vaccination programmes are rolled out,
we should ensure that the positive changes that have been made are
embedded in clinical practice to improve patient care.

\begin{enumerate}
\tightlist
\item
  Globalsurg.org. Covidsurg, NIHR Global Health Research Unit on Global
  Surgery {[}Cited 2020 Jan 18{]}. Available from
  https://globalsurg.org/covidsurg/
\item
  Cernei st al. Timing and volume of information produced for the
  Otolaryngologist during the COVID-19 pandemic in the UK. A review of
  the volume of online literature. Clin Otolaryngol;46(2):???????
\item
  Smith M, et al. Admission avoidance in tonsillitis and peritonsillar
  abscess: a prospective national audit during the initial peak of the
  COVID-19 pandemic. Clin Otolaryngol;46(2):???????
\item
  Sharma S and Daniel M. Telepmedicine in paediatric
  otorhinolaryngology: lessons learnt from remote encounters during the
  COVID19 pandemic and implications for future practice. Int J Paediatr
  Otorhinolaryngol. 2020:139:110411.
\item
  Fieux M, et al. Telemedicine for ENT: effect on quality of care during
  COVID-19 pandemic. Eur Ann Otorhinolaryngol Head Neck Dis 2020;
  137(4):257-261.
\item
  Herman A, et al. National, virtual otolaryngology training day in the
  United Kingdom during the COIVD-19 pandemic: results of a pilot
  survey. J Surg Educ. 2020; S1931-7204
\item
  McGrath BA, et al. Multidisciplinary guidance for safe tracheostomy
  care during the COVID-19 pandemic: the NHS National Patient Safety
  Improvement Programme (NatPatSIP). Anaesthesia 2020;75(12):1659-1670.
\end{enumerate}

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