An innovative approach to improve ear, nose and throat surgical access for remote living Cape York Indigenous children

Jacups, Susan P., Newman, Denise, Dean, Deborah, Richards, Ann, and McConnon, Kate M. (2017) An innovative approach to improve ear, nose and throat surgical access for remote living Cape York Indigenous children. International Journal of Pediatric Otorhinolaryngology, 100. pp. 225-231.

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Introduction: On a background of high rates of severe otitis media (OM) with associated hearing loss, children from the Torres Strait and Cape York region requiring ear, nose and throat (ENT) surgery, faced waiting times exceeding three years. After numerous clinical safety incidents were raised, indicating a failure of the current system to deliver appropriate care, the governing Hospital and Health service opted to deliver surgical care through an alternate process. ENT surgeries were performed on 16 consented children from two remote locations via the private health care system, funded by a health provider partnership.

Methods: We examined the collaboration processes alongside clinical findings from this ENT surgery. Collated patient data, included patient demographics, clinical and audiometry presentation features were reviewed and compared pre and post-operatively. Cost savings associated with the use of TeleHealth post-operatively were briefly examined.

Results: Surgeries were successfully completed in all 16 children. The reported mean waitlist time for ENT surgery was 1.2 years. Pre-surgery pure-tone average hearing thresholds were reported at left: 30.9 dB, right: 38.2 dB. The majority of presentations were for bilateral OM with Effusion (69%). Post-surgical follow up indicated successful clinical outcomes in 80% of patients and successful hearing outcomes in 88% of patients. Mean difference pure-tone average hearing thresholds, left: 8.4 dB and right: 11.2 dB. Furthermore, the majority of patients reported improved hearing and breathing. The use of TeleHealth for post-operative review enabled a minimum cost saving of AUD$21,664 for these 16 children. Overall, a high level of staffing resources was required to successfully coordinate this intense surgical activity.

Conclusion: This innovative approach to a health system crisis enabled successful ENT surgical and hearing outcomes in 16 children, whose waitlisted time grossly exceeded state health recommendations. Using private health facilities funded by a health partnership, while unlikely to be a suitable model of care for routine service delivery; may be applied as an adjunct service model when blockages and delays lead to sub-standard service provision. This approach may be applicable to other health care facilities when facing extended elective surgery wait times in ENT or other specialty areas.

Item ID: 49573
Item Type: Article (Research - C1)
ISSN: 1872-8494
Keywords: indigenous; otits media; child; tympanoplasty; chronic disease; otitis media with effusion/*therapy; audiometry; pure-tone; middle ear pathology; hearing loss; conductive/etiology; telehealth; telemedicine
Funders: Torres and Cape Hospital and Health Service (TCHHS), Apunipima Cape York Health Council, CheckUp, Royal Flying Doctor Service (RFDS)
Date Deposited: 17 Jul 2017 05:01
FoR Codes: 45 INDIGENOUS STUDIES > 4504 Aboriginal and Torres Strait Islander health and wellbeing > 450403 Aboriginal and Torres Strait Islander child health and wellbeing @ 60%
42 HEALTH SCIENCES > 4206 Public health > 420601 Community child health @ 40%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920107 Hearing, Vision, Speech and Their Disorders @ 40%
92 HEALTH > 9203 Indigenous Health > 920303 Aboriginal and Torres Strait Islander Health - Health System Performance (incl. Effectiveness of Interventions) @ 40%
92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920501 Child Health @ 20%
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