Authors (including presenting author) :
Kwan KCP (1), Lau SM (1), Yung CMJ (1), Yip E (2), Chan HL (1), Hui CWC (1), Lo N (2), Ip MW (1), Tam D (2), Yeung J (2), Wan S (2)
Affiliation :
(1) Department of Ear, Nose and Throat, Pamela Youde Nethersole Eastern Hospital
(2) Physiotherapy Department, Pamela Youde Nethersole Eastern Hospital
Introduction :
Vestibular disorder accounts for near 10% of all Ear, Nose and Throat (ENT) Specialist Out-patient Clinic (SOPC) new case referral, with routine waiting time up to more than 100 weeks. In July 2022, a new integrated service model involving nursing and allied health professionals was first introduced in our hospital to provide early assessment and management to patients with dizziness and vertigo. The encouraging pilot result demonstrated how the quality and safety of patient care in public healthcare sector could be enhanced by multidisciplinary service pathway remodeling.
Objectives :
(1) To develop a new multidisciplinary integrated service model to tackle the problem of long SOPC waiting time
(2) Provision of early clinical and audiological assessment to identify patients that require earlier doctor consultation
(3) Deliver early vestibular physiotherapy to suitable patients
(4) Enable early nursing care including patient counseling and education
Methodology :
Recruited patients would first attend a combined clinic and jointly assessed by ENT nurse and Physiotherapist within 8 weeks. Red flag cases would be identified for SOPC appointment advanced. Early electronystagmography (ENG) assessment within weeks would be arranged. Suitable patients will be given early vestibular physiotherapy including canal repositioning maneuver, gaze stabilization and habituation exercises as well as balance training within weeks. Patients were reassessed by ENT nurse in bundle clinic after ENG and completion of physiotherapy. SOPC appointment of cases with abnormal clinical features and investigation results would be advanced.
Result & Outcome :
Over a period of 5 months from 7 July to 16 December 2022, 184 patients were recruited and attended the service. 55 cases (29.9%) with red flag features were identified and with doctor appointment advanced. 113 patients (61.4%) were recruited for vestibular physiotherapy and had their first session in 12.6±10.1 days. Among those completed full course of physiotherapy, all patients demonstrated statistically significant decrease in Dizziness Handicap Inventory (DHI) score and Numeric Rating Scale (NRS) of subjective dizziness. There was also improvement in overall balance, as evident by the statistically significant improvement in Sharpened Romberg Scale and single leg stand test results. Upon outcome evaluation, more than two-third of patients report symptom improvement by 76-100%. Excellent satisfaction rate of 4.4 out of 5.0 and multiple positive feedback were obtained from our recruited patients after service completion.
