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In the face of increasing subspecialisation, how does the specialty ensure that the management of ENT emergencies is timely, appropriate and safe?

Published online by Cambridge University Press:  10 May 2016

M J Rouhani
M J Rouhani*
Affiliation:
University of Cambridge School of Clinical Medicine, UK
*
Address for correspondence: Miss Maral J Rouhani, UK Fax: +44 (0)161 475 0830 E-mail: [email protected]
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Abstract

Background:

The field of ENT surgery is one of the most varied specialties, with numerous subspecialties and continuing divergence. With this evolution there comes, however, a risk that specialists become de-skilled in certain areas. In the case of ENT emergencies, this can be particularly dangerous.

Methods:

Current guidance from relevant UK professional membership bodies regarding emergency surgery provision was inspected and a literature search was performed to identify studies relating to management of ENT emergencies in the context of increasing subspecialisation.

Results and conclusion:

The specialty currently has provisions in place to ensure timely, appropriate and safe management of emergencies, in the form of guidelines and emergency clinics; however, there is scope for improvement of the system.

Keywords

SpecializationOtorhinolaryngologyEmergencies
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 6 , June 2016 , pp. 516 - 520
Copyright
Copyright © JLO (1984) Limited 2016 

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Footnotes

Presented (and awarded the ENT-UK Undergraduate Essay Prize 2014) at the Annual General Meeting of ENT-UK, 6 February 2015, London, UK.

References

1 Ferguson, C. The arguments against fellowship training and early specialization in general surgery. Arch Surg 2003;138:915–16Google Scholar
2 Weir, N. Otorhinolaryngology. Postgrad Med J 2000;76:65–9Google Scholar
3 Ryan, MW, Johnson, F. Fellowship training in otolaryngology-head and neck surgery. Otolaryngol Clin North Am 2007;40:1311–22,viii–ixGoogle Scholar
4 Manganaris, A, Black, M, Balfour, A, Hartley, C, Jeannon, J, Simo, R. Sub-specialty training in head and neck surgical oncology in the European Union. Eur Arch Otorhinolaryngol 2009;266:1005–10Google Scholar
5 Stitzenberg, KB, Sheldon, GF. Progressive specialization within general surgery: adding to the complexity of workforce planning. J Am Coll Surg 2005;201:925–32Google Scholar
6 Bass, BL. Early specialization in surgical training: an old concept whose time has come? Semin Vasc Surg 2006;19:214–17Google Scholar
7 The Intercollegiate Surgical Curriculum: Educating the surgeons of the future. Otolaryngology Surgery. In: https://www.iscp.ac.uk/documents/syllabus_OTO_2013.pdf [3 July 2013]Google Scholar
8 Joint Committee on Surgical Training. Guidelines for the award of a CCT in Otolaryngology. In: http://www.jcst.org/quality-assurance/documents/certification-guidelines/otolaryngology-certification-guidelines [3 July 2014]Google Scholar
9 Oakley, RJ, Skilbeck, C, Simo, R. Work force planning: will the aspirations of the present group of otolaryngology specialist registrars meet the need? Clin Otolaryngol 2005;30:568–9CrossRefGoogle ScholarPubMed
10 Georgalas, C, Hadjihannas, E, Ghufoor, K, Pracy, P, Papesch, M. Operative training in otolaryngology in the United Kingdom: a specialist registrar survey. J Laryngol Otol 2005;119:356–61Google Scholar
11 Royal College of Surgeons of England. Emergency Surgery: Standards for Unscheduled Surgical Care. London: Royal College of Surgeons of England, 2011 Google Scholar
12 Royal College of Surgeons of England. Emergency Surgery: Standards for Unscheduled Surgical Care. London: Royal College of Surgeons of England, 2011;10Google Scholar
13 Royal College of Surgeons of England. Emergency Surgery: Standards for Unscheduled Surgical Care. London: Royal College of Surgeons of England, 2011;5Google Scholar
14 Royal College of Surgeons of England. Emergency Surgery: Standards for Unscheduled Surgical Care. London: Royal College of Surgeons of England, 2011;7Google Scholar
15 Royal College of Surgeons of England. Emergency Services. Round Table Meeting, 6th November 2013. In: http://webtest.rcseng.ac.uk/surgeons/emergency-services-provision-round-table [14 May 2014]Google Scholar
16 Health and Social Care Information Centre. Hospital Episode Statistics, Admitted Patient Care, England. In: http://www.hscic.gov.uk/searchcatalogue?q=title%3A%22Hospital+Episode+Statistics%2C+Admitted+patient+care+-+England%22&size=10 [14 May 2014]Google Scholar
17 Smyth, C, Moran, M, Diver, C, Hampton, S. Rapid access rather than open access leads to improved effectiveness of an ENT emergency clinic. BMJ Qual Improv Rep 2013;2 Google ScholarPubMed
18 Coulter, CA, Powell, J, Wilson, J. UK ENT emergency service provision: 4 steps to improve your emergency service. The Otorhinolaryngologist 2012;5:47–9Google Scholar
19 NHS National Services Scotland. Scottish audit of surgical mortality specialty report: data 2007. In: https://nhsnss.org/ [14 May 2014]Google Scholar
20 Bleach, N, Mady, S, Williamson, P. Emergency workload in otolaryngology. Ann R Coll Surg Engl 1994;75:335–8Google Scholar
21 Fishpool, SJ, Stanton, E, Chawishly, EK, Hicklin, LA. Audit of frequent attendees to an ENT emergency clinic. J Laryngol Otol 2009;123:1242–5Google Scholar
22 Mirza, A, McClelland, L, Daniel, M, Jones, N. The ENT emergency clinic: does senior input matter? J Laryngol Otol 2013;127:15–19 Google Scholar
23 Collins, C. The standards for emergency surgical services. J R Soc Med 2001;94:13–15 Google ScholarPubMed
24 Mylvaganam, S, Patodi, R, Campbell, JB. The ENT emergency clinic: a prospective audit to improve effectiveness of an established service. J Laryngol Otol 2009;123:229–33Google Scholar
25 Awad, Z, Pothier, DD. Management of surgical airway emergencies by junior ENT staff: a telephone survey. J Laryngol Otol 2007;121:57–60 Google Scholar
26 Wild, JR, Lambert, G, Hornby, S, Fitzgerald, JE. Emergency cross-cover of surgical specialties: consensus recommendations by the Association of Surgeons in Training. Int J Surg 2013;11:584–8Google Scholar
27 Davis, SJ, McDonald, S. Covering ENT out of hours: how confident are senior house officers? J Laryngol Otol 2006;120:587–90Google Scholar
28 Campbell, J. Inappropriate admissions: thoughts of patients and referring doctors. J R Soc Med 2001;94:628–31Google Scholar
29 Powell, J, Cooles, FA, Carrie, S, Paleri, V. Is undergraduate medical education working for ENT surgery? A survey of UK medical school graduates. J Laryngol Otol 2011;125:896–905 Google Scholar
30 Agada, FO, King-Im, JU, Atkin, SL, England, RJ. Does thyroid subspecialization alter practice and outcome? A completed 4-year audit loop. Clin Otolaryngol 2005;30:48–51 Google Scholar
31 Biondo, S, Kreisler, E, Millan, M, Fraccalvieri, D, Golda, T, Frago, R et al. Impact of surgical specialization on emergency colorectal surgery outcomes. Arch Surg 2010;145:79–86 Google Scholar
32 Robson, AJ, Richards, JM, Ohly, N, Nixon, SJ, Paterson-Brown, S. The effect of surgical subspecialization on outcomes in peptic ulcer disease complicated by perforation and bleeding. World J Surg 2008;32:1456–61Google Scholar
33 Yalamanchili, S. Why should disorders of the ear, nose and throat be treated by the same specialty? Can this situation persist? J Laryngol Otol 2009;123:367–71Google Scholar
34 Ball, CG, Hameed, SM, Brenneman, FD. Acute care surgery: a new strategy for the general surgery patients left behind. Can J Surg 2010;53:84–5Google Scholar
35 Earley, AS, Pryor, JP, Kim, PK, Hedrick, JH, Kurichi, JE, Minogue, AC et al. An acute care surgery model improves outcomes in patients with appendicitis. Ann Surg 2006;244:498–504 Google Scholar
36 Blackmore, KJ, Cocks, HC, Bosman, DA. A national audit of paediatric service provision in otolaryngology in England and Wales. Int J Pediatr Otorhinolaryngol 2007;71:757–62Google Scholar
37 ENTUK. Paediatric ENT Skills Course for Consultants. In: https://entuk.org/paediatric-ent-skills-course-consultants [20 April 2016]Google Scholar
38 Banga, R, Thirlwall, A, Corbridge, R. How well equipped are ENT wards for airway emergencies? Ann R Coll Surg Engl 2006;88:157–60Google Scholar
39 Malekzadeh, S, Malloy, KM, Chu, EE, Tompkins, J, Battista, A, Deutsch, ES. ORL emergencies boot camp: using simulation to onboard residents. Laryngoscope 2011;121:2114–21Google Scholar