scholarly journals Real-Time Operative Coding for Endoscopic Sinonasal Procedures: Quality Improvement in Practice

Sinusitis ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. 32-44
Author(s):  
Bassem Mettias ◽  
Joshua D. Whittaker ◽  
Yujay Ramakrishnan
Keyword(s):  
Quality Improvement ◽  
Endoscopic Sinus Surgery ◽  
Human Error ◽  
Financial Impact ◽  
Sinus Surgery ◽  
Clinical Coding ◽  
Tertiary Centre ◽  
Chi Squared ◽  
The Impact ◽  
Control Firm

Objective: investigate the impact of an intraoperative coding sticker (ICS) on the accuracy of coding in endoscopic sinonasal procedures. Methods: this was a two-cycle audit evaluating the accuracy (and financial impact) of intraoperative coding of sinonasal procedures at a single tertiary centre. An ICS was introduced following consultation with the coding department. The accuracy of coding was measured before (cycle 1) and after (cycle 2) the ICS was introduced to a pilot firm and compared to a control firm. The ICS was used in 35% of the pilot firm cases. Results: the accuracy of clinical coding for endoscopic sinus surgery was 60% in the first cycle. Switching to the ICS has improved the accuracy in that firm from 50% in first cycle to 70% in the second cycle (p = 0.936; Chi-squared test). The median reimbursement for endoscopic sinus surgery was equal in both cycles of £1493.00 per patient. However, inaccurate coding resulted in £109.92 excess tariff payment in first cycle and £130.96 deficiency in the second cycle. Users of ICS reported it to be easy to use for clinicians, staff and clinical coders, whilst minimizing human error. Conclusions: The integration of the ICS improves the coding in sinonasal procedures and offers low-fidelity option alternative to live coding on the computer. The accuracy was not statistically significant in the study possibly due to the low number of observations. This can allow a precise coding standard with reliable service remuneration.

scholarly journals P64 Improving surgical consent – a quality improvement project to enhance the consenting process

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Manu Shrivastava ◽  
J Brown ◽  
L Sun ◽  
Rajini Rajagopal ◽  
Manu Shrivastava
Keyword(s):  
Quality Improvement ◽  
Endoscopic Sinus Surgery ◽  
Elective Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Quality Improvement Project ◽  
Sinus Surgery ◽  
Improvement Project ◽  
Consent Forms ◽  
Educational Meeting ◽  
Patient Interviews

Abstract Introduction RCS guidelines on consent, recently updated, encourage a dialogue where all risks material to that patient are discussed and are clear. An audit was performed to assess whether practice at Oxford Hospitals is compliant with these guidelines – that all patients for elective surgery are consented prior to admission. Method Thirty-two undergoing elective Functional Endoscopic Sinus Surgery (FESS), Tonsillectomy and Septoplasty were interviewed in May-June 2019. Baseline data were presented at a local educational meeting, along with education on the recent changes to the RCS guidelines. Repeat audit took place in August-September 2020. Results All 32 patients were consented as per RCS guidelines and understood the reason for their surgery, but only 31% could explain the risks, and 56% could explain alternative options. Twenty (63%) consent forms were easily legible on randomised heuristic assessment. After education and change in department practice, understanding of the operation was much improved (80-100%). One outcome was to create pre-filled consent forms for common ENT operations. Conclusions Whilst RCS policy on completing consent prior to admission is being achieved, patient interviews suggest a lack of understanding of the operation. Standardised consent forms have the potential to enhance this understanding, as well as saving time.

Partial Endoscopic Middle Turbinectomy Augmenting Functional Endoscopic Sinus Surgery

1992 ◽  
Vol 107 (3) ◽  
pp. 382-389 ◽  
Author(s):  
William R. Lamear ◽  
William E. Davis ◽  
Jerry W. Templer ◽  
Joel P. Mckinsey ◽  
Herbierto Del Porto
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Underlying Disease ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Atrophic Rhinitis ◽  
Standard Component ◽  
Patients At Risk ◽  
Nasal Physiology ◽  
Middle Meatus Antrostomy ◽  
The Impact

Endoscopic sinus surgery has gained acceptance in the otolaryngologic community as an effective and safe method of treating inflammatory disease of the paranasal sinuses. At our institution, partial endoscopic middle turbinectomy has become a standard component of the procedure and our experience is reported. Middle turbinectomy enhances surgical exposure, specific anatomic anomalies are more completely corrected, and subpopulations of patients at risk for failure because of their underlying disease enjoy decreased rates of synechiae formation and closure of the middle meatus antrostomy when followed over time. Photodocumentation of the surgical technique and a discussion regarding the impact of middle turbinectomy on normal nasal physiology are presented. It is reported that the procedure is safe, and no complications directly attributable to middle turbinectomy (including atrophic rhinitis) are reported in a series of 298 patients.

Functional Endoscopic Sinus Surgery in Patients with Chronic Sinusitis and Asthma

1994 ◽  
Vol 110 (6) ◽  
pp. 494-500 ◽  
Author(s):  
Gary J. Nishoka ◽  
Paul R. Cook ◽  
William E. Davis ◽  
Joel P. McKinsey
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Hospital Admissions ◽  
Chronic Sinusitis ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Office Visits ◽  
Sinus Disease ◽  
Physician Office ◽  
Steroid Dependent ◽  
The Impact

Twenty asthma patients who underwent functional endoscopic sinus surgery for chronic sinusitis were studied. Medical records and questionnaire data for these 20 patients were studied regarding the Impact of sinus disease and functional endoscopic sinus surgery on their asthma. We found that 95% reported that their asthma was worsened by their sinus disease (95% confidence interval, 0.74 to 0.99+), and 85% reported that functional endoscopic sinus surgery improved their asthma (0.60 to 0.97). Of the 13 patients who used both inhalers and systemic medication, 53.8% were able to eliminate some of their medication (0.21 to 0.79). Furthermore, 61.5% of these patients had a concomitant reduction in their inhaler use (0.28 to 0.85). All patients (six) who used only inhalers experienced a reduction in their inhaler use (0.54 to 1.00), and two patients were able to eliminate their inhalers completely. One of two patients who were steroid dependent was able to discontinue steroids after surgery. Of patients who used steroids intermittently (13), 53.8% were able to eliminate the use of steroids after surgery (0.21 to 0.79). Patients who required preoperative hospital admissions (4) and emergency room or urgent physician office visits (18) had a 75.0% and 81.3% ( p < 0.001) reduction in visits, respectively, after surgery. Because 43% of the cost of asthma is the result of hospitalizations and emergency department/urgent physician office visits, a significant Impact on health care costs can be realized with functional endoscopic sinus surgery in this patient population.

The impact of endoscopic sinus surgery on paranasal physiology in simulated sinus cavities

2016 ◽  
Vol 7 (3) ◽  
pp. 248-255 ◽  
Author(s):  
Ravi Jain ◽  
Haribalan Kumar ◽  
Merryn Tawhai ◽  
Richard Douglas
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
The Impact

The impact of intraoperative antiseptic nasal irrigation during endoscopic sinus surgery on early postoperative results.

2021 ◽  
Vol 75 (2) ◽  
pp. 1-5
Author(s):  
Piotr Rot ◽  
Kornel Szczygielski ◽  
Łukasz Skrzypiec ◽  
Dariusz Jurkiewicz
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Saline Solution ◽  
Chronic Sinusitis ◽  
Study Groups ◽  
Sinus Surgery ◽  
Control Groups ◽  
Antiseptic Treatment ◽  
Blinded Study ◽  
And Control ◽  
The Impact

Introduction: The main objective of the study was to determine the validity of intraoperative antiseptic treatment during endoscopic sinus surgery and the impact of such treatment on the postoperative outcomes. Material and Methods: Fifty-five patients with chronic sinusitis, qualified for surgical treatment were enrolled into the trial. It was designed as prospective, randomized, blinded study. The surgical procedures were performed on both sides, in the same scope. In the next stage, after opening, one side was flushed with saline solution, and the other side with octenidine solution. Results: The analysis showed a statistically significant reduction in postoperative crusting measured using the Lund-Kennedy scale between the test and control groups. Intraoperative lavage of the paranasal sinuses in both control and study groups showed an effect on the decreasing total number of positive postoperative cultures relative to preoperative. Discussion: Study showed a beneficial effect of the intervention consisting in rinsing with Octenisept on the reduction of crusting in the postoperative assessment.

scholarly journals Diagnosis and Management of Depression in CRS: A Knowledge, Attitudes and Practices Survey

2020 ◽  
Author(s):  
Amarbir S. Gill ◽  
Joshua M. Levy ◽  
Machelle Wilson ◽  
E. Bradley Strong ◽  
Toby O. Steele
Keyword(s):  
Negative Impact ◽  
Hospital Setting ◽  
Cost Of Care ◽  
Screening Tools ◽  
Sinus Surgery ◽  
Prognostic Information ◽  
Attitudes And Practices ◽  
Academic Settings ◽  
Chi Squared ◽  
The Impact

Abstract Introduction Comorbid major depressive disorder (MDD) is present in up to 25% of chronic rhinosinusitis (CRS) cases and provides prognostic information for patients undergoing endoscopic sinus surgery (ESS). Clinical visits offer an opportunity to identify at-risk patients. Objective The purpose of the present study is to evaluate practice patterns among members of the American Rhinologic Society (ARS) in screening for/diagnosing MDD. Methods A 21-question survey was distributed to 1,206 members of the ARS from May 26, 2018 to June 12, 2018. The impact of demographic factors, including hospital setting, fellowship status, and experience were assessed through chi-squared analysis. Results A total of 80 members of the ARS completed the survey, yielding a response rate of 7%. Half of the respondents worked in academic settings and 43% had completed a rhinology fellowship. Twenty percent of the participants felt comfortable diagnosing or managing MDD, while only 10% of participants screened for MDD in patients with CRS. Respondents cited a lack of training (76%) and unfamiliarity with diagnostic criteria (76%) as barriers to the routine assessment of MDD. Most respondents (95%) considered comorbid psychiatric illness to negatively impact outcomes following ESS. Fellowship-trained respondents were significantly more likely to implement screening tools in their practice (p = 0.05), and believe in the negative impact of MDD on postoperative outcomes (p = 0.007), cost of care (p = 0.04) and quality of life (p = 0.047). Conclusion Amongst ARS members, 95% of the respondents consider comorbid MDD to negatively impact patient outcomes following ESS. Regardless, a large proportion of surgeons neither screen nor feel comfortable diagnosing MDD.

Sign in / Sign up

Export Citation Format

Share Document