Surgical management of otitis media with effusion in children: A rolling audit in the ENT Unit in

XXXX

ObjectiveTo evaluate how well we are adhering to

national guidelines (CG60: Surgical management of OME, Feb 2008); specifically do our paediatric patients meet the criteria for surgery

Local guidelines adapted from National NICE guideline

In cases of OME1. ≥ 3/12 of watchful waiting2. ≥ 25db of conductive hearing loss in better

ear3. Alternatives to surgery discussed

In cases of recurrent AOM1. ≥4 episodes in 6 months2. Alternatives to surgery discussed

MethodsRetrospective review of the clinical notes at pre-

admission by SHOs conducted from 20/09/2013 to 10/01/2013.

Pre-existing proforma listing the NICE criteria completed for each child listed for bilateral insertion of grommets for bilateral OME.

Completed forms then reviewed by ER and checked against clinical letters on clinical portal and adherence and non adherence recorded with details of latter cases obtained.

Results (1)

71%

14%

9%6%

Indications for bilateral grommet in-sertion

OME (15/21)Recurrent AOM (3/21)Both (2/21)Other (1/21)

• In ~3/12 there were 21 cases of children having bilateral insertion of grommets

Results 2

81%

5% 10%5%

Compliance of ENT unit with National guide-lines: CG60

Adherence (17/21)Non-adherence (1/21)Mitigating cir-cumstances (2/21)Not documented (1/21)

Results 3

0%10%20%30%40%50%60%70%80%90%

100%

5

9

3

0 0

0

0

1

0 0

2

0 0

0 0

0 0 0

0

1

Breakdown of individual clinician adherence to guidelines

Adherence Non-adherenceMitigating circumstances Not documented

SURG1 SURG2 SURG3 SURG4 SURG5

Results (4)1 case of non adherence: Patient reported 6/12 hx of

hearing loss and had a bilateral conductive hearing loss on audiometry and was listed for surgery on that first OPC appt; No 3/12 of watchful waiting. (?discussion of surg)

1st case with mitigating circumstances: Patient presented with a history of poor language development. No 3/12 of watchful waiting or formal audiometry.

2nd case with mitigating circumstances: Patient had normal audiogram, but family history of mastoiditis, recurrent episodes of AOM (not quantified)

ConclusionsLow incidence of non adherence to guidelines

(~5%)Would completing existing proforma at time of

listing patients help improve this or needlessly generate more paper-work in what are already busy clinics?

Observations made during audit:Documentation of discussion regarding

alternatives to surgery not always clear. Quantification of cases of AOM often not stated.