18 Week Patient Pathway - Glue Ear version 118 Week Patient Pathway - Glue Ear version 1.0 1.1.2...
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18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks 1.3.2 Triage Thresholds 1.3.3 Decision Aids 2.5 Diagnostic Thresholds 2.6 Decision Aids* 2.8.1 Treatment Thresholds* Wax symptoms, severity 2.8.2 Decision Aids* 3.4 Diagnostic Thresholds* 3.5 Decision Aids* Published evidence 3.3 4.4 Diagnostic Thresholds 4.5 Decision Aids* Guides (causes suspected) 4.3 2.11 3.10.2 Referral Thresholds* As 2.11.2, comorbidity 3.10.3 Decision Aids* As 2.11.3, parent leaflets 3.10.4 Remote Advice 3.10.1 RED FLAGS* Severe disease, PHI 2.2 Primary Assessment 2.7.1 No Diagnostic Required 2.7.2 Otoscopy* 2.7.3 Tympanometry* 2.7.4 Audiometry* 2.11.2 Referral Thresholds * persistent poor hearing 2.11.3 Decision Aids* Published Guidelines 2.11.4 Remote Advice 3.8.5 Pre-op Assessment (POA)* 3.2 Specialist Assessment 4.2 Subspecialist Assessment 2.3 Patient Quality of Life (QoL) Measurement Start 2.9.2 Watchful Waiting* 2.9.1 Reassurance Information Self-Help* 2.9.3 Physical/ Psychological Tx* 2.9.4 Medication* 3.8.2 Watchful Waiting* 3.8.4 Medication* 3.8.6 Invasive Tx* 3.8.1 Reassurance Information Self-Help* 3.9 Rehabilitation and Review; Quality of Life (QoL) Outcome Measurement 2.9 Definitive Treatment/s (Tx) 3.8 Definitive Treatment/s (Tx) 4.8.5 Pre-op Assessment (POA)* 4.8.2 Watchful Waiting* 4.8.4 Medication* 4.8.6 Invasive Tx* 4.8.1 Reassurance Information Self-Help* 4.8 Definitive Treatment/s (Tx) 3.8.3 Physical/ Psychological Tx* 4.8.3 Physical/ Psychological Tx* Patient 1.2 Self Assessment & Self Care (Supported/Unsupported) 2.7 Diagnostic/s (Dx) 3.6.1 No Diagnostic Required 3.6.2 Pneumatic Otoscopy* 3.6.3 Type B Tympanogram* 3.6.4 Pathology tests* 3.6 Diagnostic/s (Dx) 4.6.1 No Diagnostic Required 4.6.2 Pneumatic Otoscopy* 4.6.3 CT scan* 4.6.4 Electrophysiological test* 4.6 Diagnostic/s (Dx) 1.1 Patient Symptom* 1.1.1 Description* 1.3 2.4 2.8 3.7.1 Treatment Thresholds* HL>20dB >3mths 3.7.2 Decision Aids* 3.7 4.7.1 Treatment Thresholds* 4.7.2 Decision Aids * 4.7 3.10 4.9 Rehabilitation and Review; Quality of Life (QoL) Outcome Measurement 1.3.1 RED FLAGS* Persistence, Syndromes 2.11.1 RED FLAGS Persistence, Syndromes 1.1.3 Primary Prevention Disease Prevention Health Protection Health Promotion (e.g. Primary Care) (e.g. Interface Services - ICATS & CATS; Outpatient Services) (e.g. Specialist Outpatient Services; Tertiary Service) 3.2.1 History*: As 2.2.1, expanding on specificity of symptoms and medical history, speech and language, access to education, behaviour 3.2.2 Examination*: As 2.2.2 but pneumatic otoscopy 2.2.1 History*: Duration of symptoms, other disease, rhinitis, family history, daycare/social history 2.2.2 Examination*: Otoscopy and simple ear morphology (nose, throat, palate, neck, facies, chest, skin, height, weight) 2.9.5 Pre-op Assessment (POA) 2.9.6 Invasive Tx (Enhanced GMS) 2.10 Rehabilitation and Review; Quality of Life (QoL) Outcome Measurement e.g. NHS Direct (Internet or Phone); Pharmacy 1.2.1 History 18 Week Patient Pathway - Glue Ear version 1.0 1.1.2 Metric: Incidence & Prevalence* KEY Clock Starts Clock Stops Bad Hearing, Speech delay Can’t hear, poor behaviour, missing requests, delayed speech, heavy/ frequent symptoms of ear and respiratory infection Patient information leaflets (child and parent) * See Supplementary Information 3 mths: return earlier if symptoms worse. Recurrent AOM may need treatment Consider referral for hearing aids if hearing 30dB or more Topical nasal steroids if apparent strong allergy component As 2.9.1, plus support from another discipline desireable If not completed (ie 3 mths) or if new course of treatment commenced Significant hearing loss > 30dB - Hearing aids Ventilation tubes +/- adenoidectomy Confirming probable OME. Findings = dull TM, fluid/bubbles behind TM, amber/straw colour Confirmation of OME findings as 2.7.2, plus lack of movement on pneumatic otoscopy 5-8% persistent Flat (type B) Hearing loss/ PTA/play aud thresholds > 20dB Confirmation of hearing loss. Hearing threshold greater than 20dB Immuno- deficiency, nasal allergy Antibiotics/ear drops/topical nasal steroids. Active treatment of allergic rhinitis only if symptomatic or if other comorbidity 4.2.1 History*: As 3.2.1 with detail on additional health symptoms, comorbidity management, past history, social circumstances 4.2.2 Examination*: As 3.2.2 with detail on specifics relevant to whole health of child, pathophysiology, other pathology Confirm impact of glue ear. Findings as per 3.6.2. Speech-in-noise if impact information not consistent Confirmation of cholesteatoma. CT scan: petrous bones axial and coronal Hearing assessment in hard-to-test. Electrophysiological test including bone conduction in very young or syndromes As 2.9.1, plus specific advice about management of complicating condition Patient choice Hearing aids Antibiotics/ ear drops/ topical nasal steroids Venitlation tubes/ adenoidectomy Template Design and Image Copyright © 2007. All rights expressly reserved. Designed and authored by Dr Steven Laitner, [email protected] & Suzie Normanton, [email protected]
Transcript of 18 Week Patient Pathway - Glue Ear version 118 Week Patient Pathway - Glue Ear version 1.0 1.1.2...
18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks • 18 weeks •
1.3.2 Triage Thresholds1.3.3 Decision Aids
2.5 Diag
no
stic Th
resho
lds
2.6 Decisio
n A
ids*
2.8.1 Treatment
Thresholds*W
ax symptom
s, severity2.8.2 D
ecision Aids*
3.4 Diag
no
stic Th
resho
lds*
3.5 Decisio
n A
ids*
Pu
blish
ed evid
ence
3.3
4.4 Diag
no
stic Th
resho
lds
4.5 Decisio
n A
ids*
Gu
ides (cau
ses su
spected
)
4.3
2.113.10.2 Referral Thresholds*As 2.11.2, comorbidity3.10.3 Decision Aids*As 2.11.3, parent leaflets3.10.4 Remote Advice
3.10.1 RED FLAGS*Severe disease,PHI
2.2 Primary Assessment
2.7.1 No DiagnosticRequired
2.7.2Otoscopy*
2.7.3Tympanometry*
2.7.4Audiometry*
2.11.2 Referral Thresholds *persistent poor hearing2.11.3 Decision Aids*Published Guidelines2.11.4 Remote Advice
3.8.5 Pre-opAssessment (POA)*
3.2 Specialist Assessment
4.2 Subspecialist Assessment
2.3 Patient Quality of Life (QoL) Measurement Start
2.9.2WatchfulWaiting*
2.9.1ReassuranceInformationSelf-Help*
2.9.3Physical/PsychologicalTx*
2.9.4Medication*
3.8.2WatchfulWaiting*
3.8.4Medication*
3.8.6 Invasive Tx*
3.8.1ReassuranceInformationSelf-Help*
3.9 Rehabilitation and Review; Quality of Life (QoL) Outcome Measurement
2.9 Definitive Treatment/s (Tx) 3.8 Definitive Treatment/s (Tx)
4.8.5 Pre-opAssessment(POA)*
4.8.2WatchfulWaiting*
4.8.4Medication*
4.8.6Invasive Tx*
4.8.1ReassuranceInformationSelf-Help*
4.8 Definitive Treatment/s (Tx)
3.8.3Physical/PsychologicalTx*
4.8.3Physical/PsychologicalTx*
Patient
1.2 Self Assessment & Self Care (Supported/Unsupported)
2.7 Diagnostic/s (Dx)
3.6.1No DiagnosticRequired
3.6.2PneumaticOtoscopy*
3.6.3Type B Tympanogram*
3.6.4Pathology tests*
3.6 Diagnostic/s (Dx)
4.6.1No DiagnosticRequired
4.6.2PneumaticOtoscopy*
4.6.3CT scan*
4.6.4Electrophysiologicaltest*
4.6 Diagnostic/s (Dx)
1.1 Patient Symptom*
1.1.1 Description*
1.3
2.4
2.8
3.7.1 Treatment
Thresholds*H
L>20dB >3mths
3.7.2 Decision A
ids*
3.7
4.7.1 Treatment
Thresholds*4.7.2 D
ecision Aids *
4.7
3.10
4.9 Rehabilitation and Review; Quality of Life (QoL) Outcome Measurement
1.3.1 RED FLAGS*Persistence,Syndromes
2.11.1 RED FLAGSPersistence,Syndromes
1.1.3 Primary PreventionDisease PreventionHealth ProtectionHealth Promotion
(e.g. Primary Care) (e.g. Interface Services - ICATS & CATS; Outpatient Services) (e.g. Specialist Outpatient Services; Tertiary Service)
3.2.1 History*: As 2.2.1, expanding on specificityof symptoms and medical history, speech andlanguage, access to education, behaviour 3.2.2 Examination*: As 2.2.2 but pneumaticotoscopy
2.2.1 History*: Duration of symptoms, otherdisease, rhinitis, family history, daycare/socialhistory 2.2.2 Examination*: Otoscopy and simple earmorphology (nose, throat, palate, neck, facies,chest, skin, height, weight)
2.9.5 Pre-opAssessment(POA)
2.9.6 Invasive Tx(Enhanced GMS)
2.10 Rehabilitation and Review; Quality of Life (QoL) Outcome Measurement
e.g. NHS Direct (Internetor Phone); Pharmacy
1.2.1 History
18 Week Patient Pathway - Glue Ear version 1.0
1.1.2 Metric: Incidence & Prevalence*
KEY
Clock Starts
Clock Stops
Bad Hearing,Speech delay
Can’t hear, poorbehaviour, missingrequests, delayedspeech, heavy/frequent symptomsof ear andrespiratoryinfection
Patient information leaflets (child and parent)
* See Supplementary Information
3 mths: returnearlier ifsymptomsworse.Recurrent AOMmay needtreatment
Considerreferral for hearing aidsif hearing 30dB or more
Topical nasalsteroids ifapparentstrongallergycomponent
As 2.9.1, plussupport fromanotherdisciplinedesireable
If not completed (ie 3 mths) or if new course of treatmentcommenced
Significanthearing loss> 30dB - Hearing aids Ventilation tubes
+/- adenoidectomy
Confirmingprobable OME.Findings = dull TM, fluid/bubbles behind TM, amber/straw colour
Confirmation ofOME findings as 2.7.2, plus lackof movement onpneumaticotoscopy
5-8%persistent
Flat (type B) Hearing loss/PTA/play audthresholds> 20dB
Confirmation ofhearing loss. Hearing thresholdgreater than20dB
Immuno-deficiency, nasal allergy
Antibiotics/ear drops/topical nasal steroids.Active treatment of allergic rhinitis only if symptomatic or if other comorbidity
4.2.1 History*: As 3.2.1 with detail on additionalhealth symptoms, comorbidity management, pasthistory, social circumstances4.2.2 Examination*: As 3.2.2 with detail onspecifics relevant to whole health of child, pathophysiology, other pathology
Confirm impact of glue ear. Findings as per 3.6.2. Speech-in-noise if impact information not consistent
Confirmation ofcholesteatoma.CT scan: petrousbones axial andcoronal
Hearing assessment in hard-to-test. Electrophysiological test including bone conduction in very young or syndromes
As 2.9.1, plusspecific advice aboutmanagementof complicatingcondition
Patient choice Hearing aids Antibiotics/ear drops/topical nasalsteroids
Venitlation tubes/adenoidectomy
Template Design and Image Copyright © 2007. All rights expressly reserved. Designed and authored by Dr Steven Laitner, [email protected] & Suzie Normanton, [email protected]
