Evaluating diagnostic and management agreement between audiology and ENT: a prospective inter-rater agreement study
Jennifer Eakin1, Simone Michael2, Christopher Payten2
1Department of Speech Pathology and Audiology, Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Gold Coast, Southport, QLD, 4215, Australia. jennifer.eakin@health.qld.gov.au.
Insights
Audiologist-led care models for pediatric ear and hearing concerns are safe and efficient. This study found high agreement between audiologists and Ear, Nose, and Throat specialists on diagnosis and management.
Area of Science:
- Pediatric Otolaryngology
- Audiology
- Healthcare Management
Background:
- Ear, Nose, and Throat (ENT) primary contact models utilize audiologists for initial triage of pediatric middle ear and hearing issues.
- These models have demonstrated benefits including reduced wait times, improved ENT surgical conversion rates, and increased service capacity.
Purpose of the Study:
- To evaluate the safety and quality of an audiologist-led ENT primary contact model.
- To assess the inter-rater agreement between audiologists' and Ear, Nose, and Throat (ENT) specialists' clinical decisions for pediatric patients.
Main Methods:
- An inter-rater agreement study was conducted.
- Diagnosis and management decisions for 50 children were analyzed, comparing audiologist and ENT specialist assessments.
- The nature and patterns of disagreements were examined.
Main Results:
- 100% agreement was found on at least one site-of-lesion diagnosis.
- Primary management agreement was 74% (Gwet's AC1 = 0.67).
- Disagreements primarily involved 'watchful waiting' versus medical opinion (18%) and monitoring versus discharge (8%).
Conclusions:
- Audiologist-led primary contact models for pediatric ear and hearing concerns are both safe and efficient.
- The findings support the integration of audiologists in the primary triage of these pediatric cases.
Background:
Ear, Nose and Throat (ENT) primary contact models of care use audiologists as the first triage point for children referred to ENT for middle ear and hearing concerns; and have shown reduced waiting time, improved ENT surgical conversion rates and increased service capacity. This study aimed to investigate 'safety and quality' of the model by looking at agreement between audiologists' and an ENT's clinical decisions. METHODS: We performed an inter-rater agreement study on diagnosis and management decisions made by audiologists and an ENT for 50 children seen in an Australian hospital's ENT primary contact service, and examined the nature and patterns of disagreements.
Results:
Professionals agreed on at least one site-of-lesion diagnosis for all children (100%) and on the primary management for 74% (Gwet's AC1 = 0.67). Management disagreements clustered around i) providing 'watchful waiting' versus sooner medical opinion (18%), and ii) providing monitoring versus discharge for children with no current symptoms (8%). There were no cases where the audiologist recommended discharge when the ENT recommended further medical opinion.
Conclusions:
Our novel research provides further evidence that Audiologist-led primary contact models for children with middle ear and hearing concerns are safe as well as efficient.
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