Introduction
The design of an out-patient department is well documented,1 as are the building requirements for ENT, audiology and hearing aid clinics.2 The minimal requirements for equipment and associated matters that allow the proper functioning of an ENT out-patient department were published by ENT-UK in 1993.3 In addition, a document on the decontamination and sterilisation of rigid and flexible endoscopes was published in 2010.4
Objective
There have been significant changes in practice regarding the use of ENT out-patient equipment since the aforementioned publications. Hence, the Clinical Governance and Audit Committee of the Scottish Otolaryngological Society was asked to produce a report on the updated minimal requirements for ENT clinics in National Health Service (NHS) hospitals.
Method
This report is the result of a consultative process between the members of the Clinical Governance and Audit Committee, and was accepted by the Council and members of the Scottish Otolaryngological Society as policy.
Results
The agreed list of essential (minimal) and desirable requirements for ENT clinics in NHS hospitals are shown in Table I.
Table I Agreed list of essential and desirable requirements
Aka = also known as; HD = high definition; FNA = fine needle aspiration; PTA = pure tone audiometry
Discussion
The main functions of an out-patient department are as follows: (1) to provide specialist consultation and conduct appropriate examination; (2) to treat patients who do not require acute day-case or in-patient ward facilities; (3) to screen patients in order to determine whether day-case treatment, day-case surgery or in-patient procedures are appropriate; (4) to carry out pre-operative assessment; (5) to monitor and follow up patients after day-case treatment, day-case surgery or in-patient procedures; (6) to discharge patients from hospital care, with referral if necessary to other health service providers; (7) to counsel patients and carers; and (8) to provide an assessment and treatment facility in the event of a major disaster.1
One long-standing problem has been the difference in the standard of equipment available in some peripheral hospitals and clinics, both in urban and remote, rural areas, compared to that in the main hospitals. Colleagues have previously shown that the provision of adequate clinic equipment has medium- to long-term economic advantages, and has relevance in terms of clinical governance and potential medicolegal concerns, as significant numbers of patients have to be reviewed elsewhere when equipment in the peripheral clinic is inadequate.Reference Cain and Laing5 We seek uniformity in standards so that no patients are disadvantaged.
Another important issue is the increase in use of out-patient departments for ENT procedures. Otolaryngology as a specialty lends itself to office-based practice, and only 10–12 per cent of patients require hospital admission for procedures. As an example, in Tayside 10 800 procedures were performed in out-patient departments in 2013.
Conclusion
The provision of adequate equipment and staff has gained increasing importance as the vast majority of ENT procedures can be safely performed in the out-patient or office setting. This report by the Clinical Governance and Audit Committee of the Scottish Otolaryngological Society presents a consensus view of the minimal requirements for ENT clinics in NHS hospitals in Scotland.
Acknowledgements
The authors would like to thank Mr Peter Ross and Dr Mary-Louise Montague for their help with this paper.
