A streamlined pathway for patients with unilateral tinnitus: our experience of 22 patients.

OBJECTIVES: Unilateral tinnitus must be investigated with an IAM MRI to rule out a rare but important finding of a cerebello-pontine angle lesion. A streamlined pathway was designed to uniquely enable GPs to make direct and concurrent referrals for an IAM MRI alongside an audiology-led one-stop tinnitus clinic. The primary aim was evaluating the efficacy of the streamlined pathway. The secondary aim was to identify defect measures and associated costs. Design A prospective, experimental non-randomised control study with retrospective controls was used. Setting Participants were selected from those presenting to the local NHS trust.

PARTICIPANTS: There were 22 adult unilateral tinnitus patients in each of the experimental and control arms, presenting with no red flag or other otological signs/ symptoms or obvious treatable cause for their tinnitus. Main outcome measures Primary endpoints were referral to treatment times, number of patient healthcare visits, number of pathway steps, hand-off and lead time. Defect measures were ascertained to determine deviation from the intended pathway. The average cost of the new and old pathway were calculated.

RESULTS: The streamlined pathway demonstrated a statistically significant reduction in referral received to treatment, number of patient healthcare visits, number of pathway steps, hand-off and lead time. 50% of patients seen on the new pathway were redirected from other referrals, 18.2% lacked corresponding IAM MRI request and 54.5% of patients required additional ENT input. The streamlined pathway saved £80 per patient with unilateral tinnitus.

CONCLUSIONS: The streamlined unilateral tinnitus patient pathway confers significant benefits to patients, the NHS and wider health economy. Future research should focus on the challenge of scaling and sustaining innovation. This article is protected by copyright. All rights reserved.