Restructuring ENT out-patient services during the coronavirus disease 2019 pandemic – an iterative approach

• Published in: Journal of laryngology and otology 2020-08, Vol.134 (8), p.670-679
• Main Authors: Halliwell-Ewen, M, Atkin, B, Huins, C T, Dalton, C L
• Format: Article
• Language: English
• Subjects: Aerosols; Betacoronavirus - isolation & purification; Body Fluids - virology; Clinics; Coronaviridae; Coronavirus Infections - epidemiology; Coronavirus Infections - transmission; Coronavirus Infections - virology; Coronaviruses; COVID-19; Data collection; Disease control; Disease transmission; Hospital Restructuring - organization & administration; Humans; Incidence; Infections; Influenza; Main; Main Articles; Medical personnel; National Health Programs - organization & administration; Nursing; Otolaryngology - standards; Otorhinolaryngologic Surgical Procedures - statistics & numerical data; Outpatients - statistics & numerical data; Pandemics; Personal protective equipment; Pneumonia, Viral - epidemiology; Pneumonia, Viral - transmission; Pneumonia, Viral - virology; Prospective Studies; Quality Improvement; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Social distancing; Surgery; Surveys and Questionnaires; United Kingdom - epidemiology; Working groups
• ISSN: 0022-2151; 1748-5460
• DOI: 10.1017/S0022215120001450

Coronavirus disease 2019 has demanded enormous adjustments to National Health Service provisions. Non-urgent out-patient work was initially postponed or performed virtually, but is now being re-established. In ENT surgery, aerosol-generating procedures pose a particular challenge in out-patient settings. A rapid restructuring of ENT out-patient services is required, to safely accommodate aerosol-generating procedures and increase in-person attendances, whilst coronavirus disease 2019 persists. Data were collected prospectively over four consecutive cycles. Two surveys were conducted. Results were analysed and disseminated, with recommendations for service restructuring implemented at cycle end-points. Out-patient activity increased four-fold, associated with a significant rise in aerosol-generating procedures during the study period. Mean aerosol-generating procedure duration dropped weekly, implying a learning curve. Service restructuring occurred at cycle end-points. Iterative data gathering, results analysis and outcome dissemination enabled a swift, data-driven approach to the restructuring of ENT out-patient services. Patient and staff safety was ensured, whilst out-patient capacity was optimised.