Updating Clinical Indicators
The Clinical Indicators (CI) for Otolaryngology—Head and Neck Surgery were first developed in 1988 by the Academy’s Quality Improvement Committee (now the Patient Safety and Quality Improvement [PSQI] Committee). In 2000, the PSQI revised the CIs to include a logical argument to justify any given diagnosis. By doing so, there was greater importance attached to the quality of the history, physical examination, and diagnostic tests. The PSQI also expanded each CI to include procedure-specific post-operative observations, outcome issues suggested for use by institutions and surgeons, and a patient information section that physicians could use during surgical counseling. The PSQI also decided to develop clinical practice guidelines that would be more comprehensive and include documentation of opinions from scientific literature. We stress that CIs are not a substitute for the experience and judgment of a physician. They serve as a checklist for practitioners and a quality care review tool for clinical departments. They are intended as suggestions, not rules, and should be modified by users when deemed medically necessary. In no sense do they represent a standard of care. The applicability of an indicator for a procedure must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to CIs will not ensure successful treatment in every situation. The AAO-HNS emphasizes that CIs should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed toward obtaining the same results. The AAO-HNS is not responsible for treatment decisions or care provided by individual physicians. Because the last revision of the CIs was made well over a decade ago, AAO-HNSF decided to review the CIs to ensure they were still accurate and reflected current medical practice. As such, Bradley Marple, MD, and Richard Waguespack, MD, led the effort to review the CIs and selected 11 that needed immediate attention. These CIs are being reviewed by the Rhinology Paranasal Sinus, Pediatric Otolaryngology—Head and Neck Surgery and Oncology, Facial Plastic & Reconstructive Surgery, Airway & Swallowing, and Equilibrium Committees. Because these CIs are being reviewed, we have removed them from the website, and they will be re-posted after they are thoroughly reviewed and revised. There are 18 CIs that are not in the first group for updating, and CIs are available on our website. They are: • Acoustic Neuroma Surgery • Auditory Brainstem • Mastoidectomy • Myringotomy/Tympanostomy Tubes • Stapedectomy/Stapedotomy • Tympanoplasty • Parotidectomy • Uvulopalatopharyngoplasty • Thyroidectomy • LeFort Fracture • Mandibular Fracture • Nasal Septal Fracture • Endoscopic Debridement • Ethmoidectomy • Inferior Turbinate Surgery • Laryngectomy • Rhinoplasty • Tracheostomy If you have comments or questions about any of the CIs that are currently being updated, please email healthpolicy@entnet.org. A list of CIs being reviewed and an estimated review timeframe is listed below. To access all of the CIs, visit http://www.entnet.org/Practice/clinicalIndicators.cfm The following CIs will be posted to the website by June 2011: • Allergy Testing for Allergic Rhinitis • Caldwell-Luc • Canalith Repositioning • Diagnostic Nasal Endoscopy • Endoscopic Sinus Surgery, Adult The following CIs will be posted to the website by August 2011: • Adenoidectomy • Neck Dissection • Endoscopic Sinus Surgery, Pediatric • Laryngoscopy/Nasopharyngoscopy • Septoplasty
The Clinical Indicators (CI) for Otolaryngology—Head and Neck Surgery were first developed in 1988 by the Academy’s Quality Improvement Committee (now the Patient Safety and Quality Improvement [PSQI] Committee). In 2000, the PSQI revised the CIs to include a logical argument to justify any given diagnosis. By doing so, there was greater importance attached to the quality of the history, physical examination, and diagnostic tests. The PSQI also expanded each CI to include procedure-specific post-operative observations, outcome issues suggested for use by institutions and surgeons, and a patient information section that physicians could use during surgical counseling. The PSQI also decided to develop clinical practice guidelines that would be more comprehensive and include documentation of opinions from scientific literature.
We stress that CIs are not a substitute for the experience and judgment of a physician. They serve as a checklist for practitioners and a quality care review tool for clinical departments. They are intended as suggestions, not rules, and should be modified by users when deemed medically necessary. In no sense do they represent a standard of care. The applicability of an indicator for a procedure must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to CIs will not ensure successful treatment in every situation. The AAO-HNS emphasizes that CIs should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed toward obtaining the same results. The AAO-HNS is not responsible for treatment decisions or care provided by individual physicians.
Because the last revision of the CIs was made well over a decade ago, AAO-HNSF decided to review the CIs to ensure they were still accurate and reflected current medical practice. As such, Bradley Marple, MD, and Richard Waguespack, MD, led the effort to review the CIs and selected 11 that needed immediate attention. These CIs are being reviewed by the Rhinology Paranasal Sinus, Pediatric Otolaryngology—Head and Neck Surgery and Oncology, Facial Plastic & Reconstructive Surgery, Airway & Swallowing, and Equilibrium Committees. Because these CIs are being reviewed, we have removed them from the website, and they will be re-posted after they are thoroughly reviewed and revised. There are 18 CIs that are not in the first group for updating, and CIs are available on our website. They are:
• | Acoustic Neuroma Surgery |
• | Auditory Brainstem |
• | Mastoidectomy |
• | Myringotomy/Tympanostomy Tubes |
• | Stapedectomy/Stapedotomy |
• | Tympanoplasty |
• | Parotidectomy |
• | Uvulopalatopharyngoplasty |
• | Thyroidectomy |
• | LeFort Fracture |
• | Mandibular Fracture |
• | Nasal Septal Fracture |
• | Endoscopic Debridement |
• | Ethmoidectomy |
• | Inferior Turbinate Surgery |
• | Laryngectomy |
• | Rhinoplasty |
• | Tracheostomy |
If you have comments or questions about any of the CIs that are currently being updated, please email healthpolicy@entnet.org.
A list of CIs being reviewed and an estimated review timeframe is listed below. To access all of the CIs, visit http://www.entnet.org/Practice/clinicalIndicators.cfm
The following CIs will be posted to the website by June 2011:
• | Allergy Testing for Allergic Rhinitis |
• | Caldwell-Luc |
• | Canalith Repositioning |
• | Diagnostic Nasal Endoscopy |
• | Endoscopic Sinus Surgery, Adult |
The following CIs will be posted to the website by August 2011:
• | Adenoidectomy |
• | Neck Dissection |
• | Endoscopic Sinus Surgery, Pediatric |
• | Laryngoscopy/Nasopharyngoscopy |
• | Septoplasty |