# Quality Indicators in Otolaryngology–Head and Neck Surgery: A Scoping Review

## TL;DR

This paper reviews the development of quality indicators in otolaryngology–head and neck surgery to assess healthcare quality and identify areas needing improvement.

## Contribution

The study provides a comprehensive scoping review of quality indicator development in OHNS subdisciplines.

## Key findings

- Only 25 studies developed new quality indicators in OHNS, with a focus on otology/neurotology and pediatric OHNS.
- Most studies used Delphi methods, but patient engagement and validation of indicators were rare.
- Fewer studies addressed facial plastics and laryngology, and reporting of consensus methods was poor.

## Abstract

Quality indicators are used to evaluate the quality of healthcare delivery and as a speciality, otolaryngology–head and neck surgery (OHNS) is beginning to transition toward this empirical understanding of healthcare quality and delivery.

To describe the number and quality of studies that have developed novel quality indicators for any subdiscipline in OHNS.

We performed a database search of MEDLINE (Ovid), EMBASE (Ovid), Web of Science, and Cochrane Database of Systematic Reviews. We did not employ language or study-type restrictions and included studies published from database inception to October 2024.

Following abstract screening, 184 articles underwent full-text screen. Eligible studies developed quality indicators in any subdiscipline within OHNS. Article screening and full-text review was performed in duplicate.

We extracted study-specific and methodological data in duplicate. Quality appraisal was assessed using the Appraisal of Indicators through Research and Evaluation instrument.

We identified 10,592 studies, of which 25 studies developed new quality indicators. Quality indicator development studies primarily focused on otology/neurotology, pediatric OHNS, and head and neck surgery. Few studies investigated facial plastics, rhinology and skull base surgery, and laryngology. Most studies employed Delphi consensus methods and patient engagement was rare. Consensus methodology reporting was poor and indicators were often not validated. Outcome indicators were often measured with fewer studies investigation structure or process indicators.

Quality indicators may help standardize and improve patient care in OHNS. Future research should focus on structure and process indicators, while improving reporting, optimizing panel composition, and validating quality indicators.

Graphical Abstract