Image capture for improved diagnosis and outpatient discharge planning in ENT

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Case Study Summary
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Overview summary:
A new and innovative telemed system was implemented in order to improve the quality of service offered to ENT patients, as well as to try and reduce unnecessary referrals. The key objectives were achieved. We now plan to initiate discussions with commissioners in order to assess the benefits of using this system in primary care.
Challenge identified and actions taken :
Approximately 10% of patients referred to a hospital ENT consultant require surgery; 90% can be managed with medical therapy and/or reassurance and an explanation of their condition. HEFT receives approx. 90 referrals to its ENT service per month, and has a waiting time of 6 weeks, which is typical in England.
The ENT Directorate at HEFT wanted to:
  • reduce the number of unnecessary referrals, and thereby reduce waiting times to see more urgent cases
  • enhance efficiency in healthcare resources using telescopic referrals
  • improve the quality of care it provides to its patients
  • implement care pathways that promote patient-centred care
  • provide cost-effective and secure documentation of digital images
  • support more effective communication at multi-disciplinary team meetings by providing digital images of cases, and thereby reduce the need for patients to attend a specialist referral centre (University Hospital Birmingham)
  • improve medical teaching
The endoscope-i system ( was implemented for a trial period. This system utilises an iPhone, an endoscope, endoscope adapter and mobile app, and enables videos and images of the ear, nose and throat to be recorded in real-time. The images can then be transferred wirelessly and uploaded securely to the electronic patient record.
Impacts / outcomes:
The pilot has enabled a number of intangible benefits for both patients and clinicians. Notably, the endoscope-i system enabled an improvement to the quality of the consultation and service provided, as well as enhancing patient safety. As patients are able to view high quality images and videos of their condition, the system has enabled/supported:
  • Reassurance for patients when nothing abnormal was found in their ear, nose or throat, reducing unnecessary repeat appointments
  • Obtaining informed consent for a procedure; patients were able to see the problem and better understand the need for surgery, empowering them to play an active role in the decision-making
  • Emphasis of advice following surgery, for example, the importance of rinsing the nasal cavity; the images demonstrated that this advice was not being followed
  • Capturing images over time has enabled (remote) monitoring and review of disease states, without the need for referral, thereby reducing the amount of referrals to the outpatient department, and saving the patient from the inconvenience and expense of travelling to the hospital (this needs to be quantified).
  • The ability to access stored images remotely, and via videoconferencing, has enabled a more productive multi-disciplinary team discussion of cases; clinicians can see first hand the issue without the need to bring in the patient to the discussion. The risk of misinterpreting sketches, or sketches missing out detail, is obviated.
  • Stored images of the throat of a patient with throat cancer have been used by an anaesthetist to assess suitability for intubation pre-surgery, rather than scoping and creating an airway emergency if the patient is not fit.
Supporting quote for the innovation from key stakeholders:
A patient reported that for the first time in 15 years of attending ENT outpatient clinics, this was the first time he had actually seen a real image of his disease.

Which local or national clinical or policy priorities does this innovation address:
Reducing unnecessary outpatient visits, improving patient experience
Plans for the future:
Whilst the system was implemented as a trial, it is now embedded, and there are plans to purchase extra kit so that all ENT doctors can use it. 

We intend to initiate conversations with commissioners in order to test how this system could reduce unnecessary referals to secondary care.
Tips for adoption:
Develop good relationships with all the key stakeholders.
Fully define the challenges experienced first, then consider if this is the right solution.
Ensure there is a clinical champion.
Ensure there is support within the organisation for Apple products.
Contact for further information:
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