ORL, Head and Neck - Dual-scoring

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Introduction

Otolaryngology – Head and Neck

Dual-scoring

You are using a dual-scoring form for the Otolaryngology Head and Neck tool. You will be asked questions required to complete both the 2012 and the 2018 versions of the tool.

The score for this event will be based on the 2012 version of the tool. A second prioritisation event based on the 2018 version of the tool will also be created as a “Test” event, which you will be able to see in your history in case it is of interest. These test events will be assessed to establish an appropriate threshold before the 2018 version of the tool goes live.

General Comments and Directions

  • Scoring should be based on the considered view of the clinician taking into account the patient’s history, examination, results of investigations and the clinician’s experience in treating similar patients.
  • Criteria only apply for patients where a procedure is indicated and the patient wishes it and all non-surgical therapeutic options have been explored.
  • These criteria only apply to elective and arranged admissions.
  • Determine how severe the condition is and then allow for the duration and the frequency of occurrence of each event. Also establish how long the condition has affected the patient from initial onset.
  • The score should be calculated during the consultation, and the patient informed whether they will be accepted for publicly funded treatment. This may occur during the first or follow-up consultation, after investigations have assisted with establishing a diagnosis (e.g. CT scans).
  • If due to exceptional factors not included in the prioritisation criteria, the booking status generated does not adequately reflect the patient’s priority, the booking status may be overridden. The reason for the exception must be documented.

More than one Procedure

Where two or more related but independent procedures are contemplated at the same operating session, the score should relate to the most significant procedure.

Staged Procedures

A treatment procedure may be staged. In these cases the scoring for the staged procedure should be considered as one event.

Special cases

Automatic Priority

An appropriate priority score reflecting the clinically appropriate timeframe for treatment will be automatically assigned for the following cases:

Note: all skin lesions should be assessed on the Skin Lesion tool instead.

 
  • (non-skin)
  •  

  • Paediatric ORL special cases

  • (speech delay)
  • (cholesteatoma, retraction pocket, ossicular erosion, perforation, keratin)
  •  

Prioritisation

Otolaryngology

Impact on Life
Severity of impact on life
  • (Makes important activities more difficult)
Duration = number of days per episode that the condition impacts important activities
Frequency = number of episodes per year
Overall duration on impact on life
Risk of Progression and Complications
Risk of progression and complications arising from this condition using the natural history and the current stage.
Likelihood of Progression
Likelihood of progression or deterioration in the next 12 months
  • (stable condition unlikely to deteriorate)
  • (gradual or possible deterioration)
  • (rapid or expected deterioration)
Significance of Progression
Significance of progression or deterioration in the next 12 months
  • (little clinical change)
  • (increase, more urgent or complex intervention necessary, poorer outcome)
  • (life threatening, significant functional impact or organ threatening)
Amount of Benefit
The benefit that is expected or most likely from the proposed treatment
  • (marginal benefit compared to risk)
  • (50% improvement)
  • (80% improvement)
  • (near complete reversibility of the Impact on Life, prevention of the risk of progression)
Amount of Benefit – 2012
  • (marginal benefit compared to risk)
  • (80% improvement)
Risk of Complications / Adverse effects of the surgical procedure
  • (e.g. BMI > 35, MI last 6/12, Cardiac failure, Respiratory failure)
  • (e.g. PHx DVT/PE, Ischaemic heart disease)
New special cases
  • (exclude lipoma)
  • (with/without aspiration/feeding issues)
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