Remote assessment and practice implementation for disorders in ears, nose and throat: a mixed-methodology observational study in the United Kingdom

Clinical Snapshot

Key Findings

• P Value: Not applicable - protocol stage

• Effect Size: To be determined from completed study

• Primary Outcome: Protocol paper - results pending. Primary outcomes include clinical effectiveness, cost-effectiveness, and patient satisfaction

• Nnt Or Sensitivity: Economic evaluation planned following NICE guidelines with cost-effectiveness ratios to be calculated

• Confidence Interval: Not applicable - protocol stage

Clinical Application

High feasibility given existing telehealth infrastructure. Requires trained staff, endoscopic equipment, and secure digital platforms Highly relevant to Australian healthcare with similar ENT waiting time challenges. Could inform Medicare telehealth item development and state health service delivery models. Aligns with RACGP telehealth guidelines and TGA digital health regulations ENT patients suitable for remote assessment, particularly those with conditions manageable through advice and non-surgical interventions

Abstract

INTRODUCTION: Ear, nose and throat (ENT) conditions are highly prevalent in primary and secondary care, yet patients frequently face prolonged waits for specialist review. In England, over half of ENT patients wait beyond the NHS 18-week referral-to-treatment target. Many of these cases can be effectively managed with advice and non-surgical interventions, presenting an opportunity for remote service innovation.This study aims to evaluate the clinical effectiveness, cost-effectiveness, acceptability and environmental sustainability of a digitally enabled remote ENT clinic model compared with traditional face-to-face pathways. METHODS AND ANALYSIS: This single-centre, mixed-methods, prospective cohort study will be conducted at University Hospitals Birmingham NHS Foundation Trust. Remote clinics will use trained staff to collect diagnostic data (including endoscopic imaging and boothless hearing tests) for consultant review via secure cloud-based software. Quantitative analysis will assess patient outcomes, costs, waiting times, carbon footprint and satisfaction. Qualitative data from semi-structured interviews with patients, clinicians and managers will explore acceptability, scalability and barriers to implementation. The qualitative data will be analysed using the framework methodology, according to the non-adoption, abandonment, scale-up, spread and sustainability framework, while the strengthening the reporting of observational studies in epidemiology framework will be used to guide the reporting of quantitative data. Cost-effectiveness analyses will follow NICE guidelines, while environmental impact will be measurement will be informed by the sustainability in quality improvement framework. Recruitment will be aiming for 300 completed datasets and 30-35 interviews. ETHICS AND DISSEMINATION: Ethical approval has been granted (IRAS 350908; REC 25/SW/0116). Findings will be disseminated via conferences, peer-reviewed journals and institutional communication channels.

References

1. 1.Spinos, D., Beech, T., Coulson, C., Greenfield, S., Litchfield, I., Nankivell, P., Allen, R., & Muzaffar, J. (2026). Remote assessment and practice implementation for disorders in ears, nose and throat: a mixed-methodology observational study in the United Kingdom. BMJ Open. https://doi.org/10.1136/bmjopen-2025-115521