Authors (including presenting author) :
Yeung WCZ (1), Cho HW (1), Fung WM (1), Chan MY (1), Hui CS (1), Tian L (2), Yang JT (2), Wu YT (2), Wang YX (2), Yu M (2), Shen YW (2)
Affiliation :
(1) Department of Ear, Nose and Throat, United Christian Hospital and Tseung Kwan O Hospital (2) Department of Information Systems, Business Statistics and Operations Management The Hong Kong University of Science and Technology
Keyword 1: :
ENT SOPD Waiting Time
Keyword 2: :
Nurse-led Clinic
Keyword 3: :
Elderly Hearing Loss
Introduction :
Elderly hearing loss is highly prevalent, affecting about 20% of adults aged 65 and rising to 70% by age 80, with substantial impacts on communication, social participation, psychological well-being, and cognitive health. In Hong Kong’s aging population, approximately one‑fifth of new ENT referrals are attributed to elderly hearing loss, yet routine specialist outpatient waiting times exceed 80 weeks, reflecting limited ENT manpower and escalating service demand. To bridge the gap between clinical effectiveness and healthcare efficiency, a nurse‑led elderly hearing clinic was introduced in 2021 within a tertiary ENT service, to expedite hearing assessment and rehabilitation.
Objectives :
The present study aimed to: - Evaluate whether a nurse‑led elderly hearing clinic could reduce waiting time to first assessment and hearing‑aid prescription compared with the traditional doctor‑first pathway. - Assess the impact of nurse‑first triage on consultation duration, number of follow‑up visits, and discharge efficiency in ENT specialist clinics. - Determine patient satisfaction and perceived understanding of hearing loss following nurse‑led care. - Examine diagnostic concordance and safety by comparing nurses’ and doctors’ diagnoses and management plans and identifying any missed sinister pathology. - Estimate the cost saving implications and propose future model to enhance the nurse-led elderly hearing clinic
Methodology :
This retrospective cohort study included a total of 4,530 patients with 6,773 attendance records, encompassing both pre- and post-implementation periods of nurse-led clinics. Data on patient waiting times and doctor consultation durations were collected and compared before and after the introduction of nurse-led services to evaluate the impact on clinical workflow efficiency. Patient acceptability and clinic effectiveness were assessed through a satisfaction survey, completed by 626 patients following their attendance at the nurse-led clinic. The survey results were systematically analyzed to gauge patient perspectives on service quality and overall satisfaction. A focused analysis was conducted on 373 patients who were managed within the nurse-led clinic framework. Correlation and agreement analyses were performed to compare the management plans initiated by specialist nurses with those of ENT doctors, thereby evaluating the consistency and safety of nurse-led clinical decision-making. In addition, an operational cost analysis was performed to estimate the resource savings attributable to the nurse-led model. The economic impact of this service transformation on the public healthcare system in Hong Kong was assessed by quantifying reductions in doctor consultation time and improved resource allocation. Data were extracted from the Electronic Patient Records (ePR) system, encompassing the following variables: • Demographic data: age, gender • Waiting time: defined as the interval between the date of referral letter submission and the appointment date for both the nurse-led clinic and ENT specialist clinic • Consultation duration: calculated as the difference between consultation start and end times • Clinical records: individual patient encounters were reviewed to assess investigations ordered and treatment plans formulated by specialist nurses and ENT doctors Statistical Analysis: Chi-square test was used to compare the nominal variable such as gender, while two sample independent t test and One-way ANOVA were used to compare continuous variables. Analyses were performed using SPSS, with 2 sided p < 0.05 considered statistically significant.
Result & Outcome :
Implementation of the nurse‑led clinic resulted in a 62% reduction in average waiting time for elderly hearing loss cases, from more than 60 weeks to 24 weeks (p< 0.001). Mean doctor consultation time decreased by 1.8 minutes per patient, corresponding to approximately 6,000 specialist minutes saved annually; concurrently, the proportion of patients discharged after a single doctor visit increased from 12.0% to 46.4%, and the mean number of follow‑up visits fell from 2.27 to 1.68 (all p< 0.001). Among 626 survey respondents, overall satisfaction with the nurse‑led clinic was high, with a mean score of 3.88/4 and 88% rating the service 4/4, frequently citing longer consultation time (20 vs 10.4 minutes) and clearer explanation of hearing loss compared with standard doctor‑only care. Diagnostic and management concordance between nurses and ENT specialists was 86.3%; in the remaining 13.7% of cases, doctors mainly added treatment for rhinitis, otitis media or externa, and no sinister diagnoses such as malignancy or life‑threatening infection were missed. Under the current configuration, the program generated an estimated annual net saving of approximately HK$62,000. Building on these findings, a future three‑tier model is proposed in which family medicine serves as gate‑keeper and up to 85% of elderly hearing loss patients are managed and discharged through the combined family medicine–nurse clinic pathway, reserving ENT specialist for the remaining 15% cases with complex needs. In this scenario, projected annual savings increase to HK$254,126, and ENT surgeons are expected to reallocate time to higher‑complexity cases, enabling an estimated 17.4% increase in new ENT case throughput per year.
