Achieving consensus in follow-up practice for routine ENT procedures: a Delphi exercise

To generate consensus amongst faculty members regarding follow-up practice for well-defined clinical scenarios using a Delphi exercise and to identify whether disseminating the consensus guidelines changed follow-up practice.

Generation of consensus using a Delphi exercise and an audit of follow-up practice before and after dissemination of the resultant guidelines.

The department of Otorhinolaryngology-Head and Neck Surgery at the Freeman Hospital, Newcastle upon Tyne, UK.

Panel members for this exercise included 11 consultants and two associate specialists and one co-ordinator. We identified clinical scenarios where ≥ 80% agreement existed that routine follow-up appointments should not be made and subsequently disseminated guidelines widely to all medical staff. The follow-up rates for the scenarios where consensus existed regarding follow-up practice were audited from clinic letters before and after the guidelines were disseminated.

Agreement on scenarios where routine follow-up appointments should not be made was assessed using a Likert scale (1-5).

Of 13 faculty members, 12 responded to rounds one and two, and 11 responded to round three. The Delphi exercise identified 18 clinical scenarios where there was ≥ 80% agreement on patients not routinely being followed up. Comparison of the follow-up practice prior to and after the Delphi exercise identified a reduction in follow-up for all 18 scenarios of 48%.

Consensus regarding routine follow-up can be reached by using the Delphi process in ENT practice. This can translate into a real change in clinical practice. Furthermore, this process could be applied for consensus building in other related areas.