Kwan KCP (1), Lau SM (1), Yung CMJ (1), Lo HK (2), Chan HL (1), Hui CWC (1), Yip E (2), Ip MW (1), Tam D (2), Yeung J (2), Wan S (2)
(1) Department of Ear, Nose and Throat (ENT), Pamela Youde Nethersole Eastern Hospital
(2) Physiotherapy Department, Pamela Youde Nethersole Eastern Hospital
Introduction
Vestibular disorder accounts for near 10% of all Ear, Nose and Throat (ENT) Specialist Out-patient Clinic (SOPC) new case referral, with long routine waiting time. In 2022, a new integrated service model involving nursing and different allied health professionals was first introduced in Hong Kong East Cluster to provide early assessment and management to patients with dizziness, vertigo and balance problem.
Objectives
To develop a new multidisciplinary integrated service model to tackle the problem of long SOPC waiting time by providing priority vestibular assessment, timely vestibular physiotherapy and early nursing care to patients.
Methodology
Over a period of 19 months from 7 July 2022 to 7 February 2024, 564 patients were recruited and attended IVC. They first attended a combined clinic and were jointly assessed by ENT nurses and Physiotherapists within 8 weeks. Patients with red flag features were identified and with doctor appointment advanced. 291 patients (51.6%) were arranged vestibular physiotherapy and had their first session within 8 weeks. All patients went on with early videonystagmography (VNG) assessment by audiologists whilst suitable patients would be given early vestibular physiotherapy including canalith repositioning maneuver, gaze stabilization, habituation exercises and balance training. Patients were reassessed by ENT nurse in bundle clinic after VNG and completion of rehabilitation. SOPC appointment of cases with suspected red flag features would be advanced along service pathway.
Results
Among those completed full course of physiotherapy, all patients demonstrated statistically significant decrease in Dizziness Handicap Inventory (DHI) score and Numeric Rating Scale (NRS) of subjective dizziness, while balance (Sharpened Romberg Scale and single leg stand test) was reported statistically significantly improved. Upon outcome evaluation, more than two-third of patients reported symptoms relieved by 70-100%.
Conclusions and Public Health Implications
The encouraging results demonstrated how a multidisciplinary service pathway remodeling could drastically shorten the waiting time and enhance the quality and safety of patient care in public healthcare sector.
