On the minimum requirements for otolaryngology

clinics in NHS hospitals

Report by the Clinical Governance & Audit Committee of the Scottish
Otolaryngological Society (ENT Scotland) March 2014.

Musheer Hussain (Chair) David Baring (Lothian) Angus Cain (Highland) Andrew
Clement (Glasgow & Clyde) John Dempster (Ayrshire) Kerry Haddow (Fife)
Stephen Jones (Tayside) Balaji Natarajan (Lanarkshire) Bhasker Ram
(Grampian) Saghir Sheikh (Glasgow & Clyde) Aileen White (Glasgow & Clyde)

The design of an out-patients department is well documented1as are the building

requirements for ENT, audiology and hearing aid clinics2. The minimal
requirements for equipment and associated matters that allow the proper
functioning of an ENT outpatient department was published by ENT UK in 19933
and a document on decontamination and sterilization of rigid and flexible
endoscopes was published in 20104.

There have been significant changes in practice in the use of equipment since so
that the Clinical Governance & Audit Committee (CGAC) was asked to produce a
report on the updated minimal requirements for Otolaryngology clinics in NHS
hospitals.

This report is the result of a consultative process between the members of the
CGAC and will be presented to the Council and membership of the society.

The main functions of an Outpatients department are1

1. Specialist consultation and examination

2. Treatment of patients who do not require the facilities of either an acute
day patient or in-patient ward
3. Screening for the selection of patients for day case treatment, day surgery
or in-patient procedures
4. Pre-operative assessment
5. Following up and monitoring the condition of patients after day case
treatment, day surgery or in-patient procedures
6. Discharging patients from the care of the hospital, with referral if
necessary to other health service providers
7. Counseling patients and carers
8. Additionally, the OPD may provide an assessment and treatment facility
in the event of a major disaster

One long standing problem has been the difference in the standard of equipment
available in some peripheral hospitals/clinics both in urban and remote and
rural areas compared to the main hospitals. Colleagues have previously shown5
that the provision of adequate clinic equipment have medium to long term
economic advantages and also has relevance in relation to clinical governance
and potential medico-legal concerns, as significant numbers of patients have to
be reviewed elsewhere when equipment is inadequate in the peripheral clinic.
We seek uniformity in standards so that patients are not disadvantaged.

The other important point to make is that there has been an increase in use of
outpatients for ENT procedures as the specialty lends itself to office based
practice and only 10-12 percent of patients require hospital admission for
procedures. As an example in Tayside 10,800 procedures were performed in the
out patients in 2013.

The agreed list of essential (minimal) and desirable requirements are as follows:

Essential Desirable

LARYNGOLOGY / HEAD & NECK

Flexible Naso-laryngoscopy equipment Flexible video-rhino-laryngoscope
(in sufficient numbers|) (also known as HD Chip in Tip
Head light Endoscope)
Tongue depressors
FNA Equipment
True-cut biopsy equipment

VOICE CLINIC
Flexible Nasolaryngoscope with
stroboscopy, and video capture.
Rigid Laryngoscope for voice
assessment
Flexible video-rhino-laryngoscope
(also known as HD Chip in Tip
Endoscope)

RHINOLOGY /FPS
Rigid nasal endoscopy (in sufficient HD Endoscope camera
numbers) Facilities for inhalant allergy
Nasal speculae assessment
Biopsy instruments Equipment for physical airway
Cautery equipment measurement
Nasal packs and associated equipment Facility for skin prick tests for allergy
Endoscope cameras and access to
medical photography

OTOLOGY
Otoscopes Fine middle ear instruments tray
Microscope and otoendoscopes
Aural speculae
Suction and other aural instruments
Tuning forks

Photo / video documentation

Endoscopic / microscopic images Flexible video-rhino-laryngoscope
External images by digital camera or Video recording equipment
medical photography
Printer for still images in medical
records

CLINIC AREA
Examination couch Adjustable dental type chair
Hand wash basin
Decontamination & sterilisation
facilities to national standards
Patient information leaflets and clinic
wait time display board

Human Resources: Adequate numbers

of nurses (1 per clinic room) and
audiologists
Availability of drugs commonly used in
OP

Sound proof booth to British standard Speech audiometry

Regularly calibrated audiometer for
pure tone audiometry and
tympanometer equipment
Vestibular assessment facilities for
Vestibular clinic
Computer in each clinic room with
internet and printer access

Acknowledgement: I would like to thank Mr Peter Ross and Dr Mary-Louise

Montague for their help.

References
1. Health Building Note 12 (HBN12) DOH guidance on the design of an out-
patients department that is attached to, or forms part of, an acute
hospital or treatment centre. 1990 NHS Leeds

2. HEALTH BUILDING NOTE 12 SUPPLEMENT 3 Out-patients department

Supplement 3 - ENT and audiology clinics, hearing aid centres 1994
Amended NHS Wales 2013

3. Minimum requirements for otolaryngology departments in NHS

hospitals. The British Association of Otolaryngologists, London 1993

4. Guidance on the decontamination and sterilization of rigid and flexible

endoscopes ENT UK 2010 https://entuk.org/professionals/publications
Accessed March 2014
5. Cain AJ, Laing MR A review of otolaryngology equipment provision in a
peripheral clinic setting. Health Bull (Edin). 2000 Nov;58(6):467-70