2. Aim To assess the effectiveness of medical or surgical treatment in patients with sino-nasal disease who present to ENT outpatient clinics

3. Method  Forms collected between 1st September 2013 - 24th December 2013 (some forms were dated outwith these periods)  Patients complete SNOT questionnaire prior to consultation  Consultant completes clinical information on form  Data from forms recorded on an Excel spreadsheet  Paper copies filed alphabetically for each consultant  Incomplete forms filed separately  Sources of SNOT scores for the audit were:  SNOT forms collected in this audit cycle  Previously filed forms  SCI-store letters

4. What is the SNOT Questionnaire?  A patient-reported measure of outcome in treatment of sino-nasal disorders  The SNOT questionnaire contains 20 questions  The first half of the questionnaire relates to physical symptoms – nasal, ear, and facial symptoms  The second half relates to quality of life (sleep and psychological issues) http://www.entnet.org/research/outcomes/browne%202007.pdf health related quality of life

5. Results  404 forms returned  126 forms were able to be used in the audit (criteria for inclusion: Name, CHI, diagnosis, treatment, pre/post, and at least one SNOT score)  278 forms excluded from this audit cycle:  Only pre-treatment score available at present (166)  Discharged after 1 st appointment (8)  DNA 2 nd appointment (3)  Non sino-nasal disease (2)  Only post-treatment score available (31)  Forms missing name, diagnosis or treatment (68)

6. Surgeon A Number of Cases Average pre- treatment SNOT score Average post- treatment SNOT score Average improvement in SNOT score Number of patients improved MEDICAL TREATMENT365044623 (64%) FESS + REVISION FESS646838 5 (83%) FESS + SEPTOPLASTY122814 1 (100%) SEPTOPLASTY +/- INFERIOR TURBINATE REDUCTION 7341420 6 (86%) SEPTORHINOPLASTY161547 1 (100%) Total51

7. Surgeon B Number of Cases Average pre- treatment SNOT score Average post- treatment SNOT score Average improvement in SNOT score Number of patients improved MEDICAL TREATMENT2545311413 (52%) FESS + REVISION FESS1343162714 (93%) FESS + SEPTOPLASTY4441628 4 (100%) SEPTORHINOPLASTY5361323 4 (80%) Total Cases47

8. Surgeon C Number of Cases Average pre- treatment SNOT score Average post- treatment SNOT score Average improvement in SNOT score Number of patients improved MEDICAL TREATMENT153527812 (80%) FESS + REVISION FESS3412615 3 (100%) SEPTORHINOPLASTY103919209 (90%) Total Cases28

9. Results Number of Patients Patients with Improvement in Symptoms Patients with Worsening of symptoms Symptoms Unchanged MEDICAL TREATMENT7651 (67%)21 (28%)4 (5%) FESS + REVISION FESS2221 (96%)0 (0%)1 (4%) FESS + SEPTOPLASTY5 5 (100%) 0 (0%) SEPTOPLASTY +/- INFERIOR TURBINATE REDUCTION 7 6 (86%)1 (14%)0 (0%) SEPTORHINOPLASTY1614 (88%)2 (12%)0 (0%) Total number of Patients126

10. What Went Wrong?  SNOT forms still not being completed fully  31 post-treatment SNOT forms did not have a pre-treatment form/score recorded on the form, available from the previously filed forms, or on SCI-store  There is not a reliable way to hand over the audit data to the next group of doctors

11. Suggestions For Improvement  SNOT scores could be recorded in the patient notes at clinic appointments, enabling them to be easily located at the next appointment, and so written on the next SNOT form  If SNOT scores were recorded in all dictated letters, this would provide an easily accessible record of the score should the SNOT form not be fully completed in clinic