Objective: ePrescriptions are associated with increased patient satisfaction, decreased provider burden, decreased administrative costs, and a positive impact on planetary health. We aimed to attain 20% overall usage of ePrescriptions in the Department of Otolaryngology-Head and Neck Surgery (OHNS) at the London Health Sciences Centre (LHSC) by December 2023. Method: This project followed the Institute for Healthcare Improvement model and used a pre-post intervention design. A root-cause analysis identified potential obstacles to ePrescribing. Change ideas, including educational seminars, surveys, quarterly reporting of ePrescription usage, and public encouragement of top ePrescribers in the department, were implemented and tested using Plan-Do-Study-Act cycles. ePrescription usage and carbon footprint savings associated with ePrescriptions were measured. Provider and patient satisfaction surveys were conducted as balancing measures for perception of increased burden on providers. Results: During the pre-intervention and post-intervention phases, a total of 400 and 1000 ePrescriptions were prescribed by the department, respectively. There was a statistically significant increase in the mean proportion of ePrescription used before (mean: 9.7%; sd=7.6) and after (mean: 40.7%; sd=6.4) the intervention (p<0.001), which exceeded the goal. SPC charting suggested special cause variation, signifying a statistically significant improvement. Additionally, a reduction of 125.9 lbs of CO 2 equivalents was associated with ePrescription use. 66.7% of providers rated overall satisfaction with ePrescriptions at 7/10 or higher, and 76.9% indicated that patients either sometimes, usually, or always opted for ePrescriptions when given the choice. Conclusion: Our change ideas increased ePrescription usage in an academic OHNS department and was associated with increased planetary health savings and provider satisfaction.

Objectives: Nasopharyngeal (NP) depth prediction is clinically relevant in performing medical procedures, and enhancing technique precision and safety for patients. Nonetheless, clinical predictive variables and normative data in adults remain limited. This study aimed to determine normative data on NP depth and its correlation to external facial measurements. Methods: A multicenter cross-sectional study obtained data from adults presenting to otolaryngology clinics at five sites in Canada, Italy, and Spain. Investigators compared the endoscopically measured depth from sill to nasopharynx along the nasal floor to the facial measurements “curved distance from the alar-facial groove along the face to the tragus” and “distance from the tragus to a plane perpendicular to the philtrum.” When sinus CT images were available, the distance from the nasopharynx to nasal sill was also collected. Results: 371 patients participated in the study (41% women; 51 years old, SD 18). The average endoscopic depth was 9.4 cm (SD 0.86) and 10.1 cm (SD 0.9) for women and men, respectively (p<0.001; 95% CI 0.46 to 0.86). Perpendicular distance was strongly correlated to NP depth (r=0.775; p<0.001), with an average underestimation of 0.1 cm (SD 0.65; 95% CI 0.06 to 0.2). The equation: ND(cm) = perpendicular distance*0.773 + 2.344, generated from 271 randomly selected participants, and validated on 100 participants, resulted in a 0.03 cm prediction error (SD 0.61; 95% CI -0.08 to 0.16). Conclusions: Nasopharyngeal depth can be accurately approximated by the distance from the tragus to a plane perpendicular to philtrum. The generated predictive equation was most accurate but not likely clinically relevant.