An innovative approach to improve ear, nose and throat surgical access for remote living Cape York Indigenous children

Introduction: On a background of high rates of severe otitis media (OM) with associated hearing loss,
children from the Torres Strait and Cape York region requiring ear, nose and throat (ENT) surgery, faced
waiting times exceeding three years. After numerous clinical safety incidents were raised, indicating a
failure of the current system to deliver appropriate care, the governing Hospital and Health service opted
to deliver surgical care through an alternate process. ENT surgeries were performed on 16 consented
children from two remote locations via the private health care system, funded by a health provider
partnership.
Methods: We examined the collaboration processes alongside clinical findings from this ENT surgery.
Collated patient data, included patient demographics, clinical and audiometry presentation features
were reviewed and compared pre and post-operatively. Cost savings associated with the use of Tele-
Health post-operatively were briefly examined.
Results: Surgeries were successfully completed in all 16 children. The reported mean waitlist time for
ENT surgery was 1.2 years. Pre-surgery pure-tone average hearing thresholds were reported at left:
30.9 dB, right: 38.2 dB. The majority of presentations were for bilateral OM with Effusion (69%). Postsurgical
follow up indicated successful clinical outcomes in 80% of patients and successful hearing
outcomes in 88% of patients. Mean difference pure-tone average hearing thresholds, left: 8.4 dB and
right: 11.2 dB. Furthermore, the majority of patients reported improved hearing and breathing. The use of
TeleHealth for post-operative review enabled a minimum cost saving of AUD$21,664 for these 16 children.
Overall, a high level of staffing resources was required to successfully coordinate this intense
surgical activity.
Conclusion: This innovative approach to a health system crisis enabled successful ENT surgical and
hearing outcomes in 16 children, whose waitlisted time grossly exceeded state health recommendations.
Using private health facilities funded by a health partnership, while unlikely to be a suitable model of
care for routine service delivery; may be applied as an adjunct service model when blockages and delays
lead to sub-standard service provision. This approach may be applicable to other health care facilities
when facing extended elective surgery wait times in ENT or other specialty areas.
© 2017 Elsevier B.V.