Abstract
Grommets insertion is a common otolaryngological procedure for the treatment of persistent otitis media with effusion. In 2002, the Department of Health (DoH) Day Surgery guidelines stipulated that at least 75% of grommets insertions should be undertaken as day-cases. In 2008, after governmental perception of a higher than necessary grommet insertion rate, the National Institute for Health and Clinical Excellence (NICE) guidelines aimed at reducing inappropriate grommet insertions. This study analyses the effect these national interventions have had on grommets insertion in England and Wales. A retrospective study was undertaken. Data were extracted from the patient episode databases of England (Health Episode Statistics) and Wales (Patient Episode Database of Wales) from 2000 until 2010 using OPCS-4 code D151. Statistical change in practice following the introduction of the interventions was assessed using linear regression. Results: 341,526 and 16,400 grommets insertions were performed in England and Wales, respectively. Linear regression analysis demonstrated that implementation of the Day Surgery guidelines significantly improved day-case rates in both national cohorts (England P < 0.0001, Wales P < 0.0001) and reduced mean waiting times for grommets insertion in both cohorts (England P < 0.05, Wales P < 0.01). Regression analysis also showed that implementation of the NICE guidelines had no effect on the number of grommet insertions in England (P > 0.5) and Wales (P > 0.5). In conclusion, the DoH guidelines have increased grommets day-case provision and reduced waiting times in both England and Wales, whereas the NICE guidelines have not affected overall levels of grommet insertion in either national cohort.
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References
Lous J, Burton MJ, Felding J, Ovesen T, Rovers M, Williamson I (2005) Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev, Issue 1. doi: 10.1002/14651858.CD001801.pub2
Browning GG, Rovers MM, Williamson I, Lous J, Burton MJ (2010) Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev, Issue 10. doi: 10.1002/14651858.CD001801.pub3
Department of Health (2002) Day surgery: Operational guide: Waiting, booking and choice
The Audit Commission (2001) Acute hospital portfolio—review of national findings: day surgery
Department of Health (2000) The NHS Plan: a plan for investment, a plan for reform
National Institute for Health and Clinical Excellence (2008) Surgical management of otitis media with effusion in children. Clinical guideline
Hospital Episode Statistics online (2005) Main procedures and interventions: 4 character. http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=215. Accessed on 20 January 2011
Patient Episode Database for Wales (2000) Annual PEDW data tables: main operation (4 character detail). http://www.infoandstats.wales.nhs.uk/page.cfm?orgid=869&pid=41010&subjectlist=Main+Operation+%284+character+detail%29&patientcoverlist=0&period=0&keyword=&action=Search. Accessed on 20 January 2011
Office for National Statistics (2010) Population estimates for UK, England and Wales, Scotland and Northern Ireland—current datasets. http://www.statistics.gov.uk/statbase/product.asp?vlnk=15106. Accessed on 18 January 2011
Auditor General for Wales (2006) Making better use of NHS day surgery in Wales
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Al-Hussaini, A., Owens, D. & Tomkinson, A. Have two UK national guidelines had any effect on grommets day-case utilisation and rate over the last 10 years?. Eur Arch Otorhinolaryngol 269, 2053–2056 (2012). https://doi.org/10.1007/s00405-011-1860-z
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DOI: https://doi.org/10.1007/s00405-011-1860-z