# Improving Clinical Management in ENT Casualty: A Multi-domain Quality Improvement Project Using a Digital Toolkit

## TL;DR

A digital toolkit improved how junior doctors manage common ENT emergencies, boosting care quality and confidence.

## Contribution

A scalable, low-cost digital toolkit was developed and shown to enhance clinical decision-making and documentation in ENT casualty settings.

## Key findings

- Documentation of tympanic membrane integrity improved from 34.3% to 67.7%.
- Audiogram performance within 24 hours for SSNHL increased from 33.3% to 80%.
- Appropriate cautery use in epistaxis rose from 87.2% to 98.1%.

## Abstract

Background: Foundation year (FY) doctors rotating through otorhinolaryngology (ENT) are frequently required to manage high-risk acute presentations with limited speciality training, leading to variability in care quality and documentation.

Aim: This quality improvement (QI) project evaluated whether a digital clinical decision-support toolkit could improve adherence to evidence-based benchmarks across four common ENT casualty presentations: otitis externa, nasal fracture, sudden sensorineural hearing loss (SSNHL), and epistaxis.

Methods: Two audit cycles were performed over 10 weeks in a tertiary centre, including 203 patients in cycle 1 and 192 patients in cycle 2. Between cycles, a real-time ENT toolkit website with quick response (QR) code access, structured documentation templates, and guideline summaries was introduced to FY doctors at induction. Compliance with international standards was compared across cycles, supplemented by staff survey feedback using a five-point Likert scale.

Results: Significant improvements were observed in multiple domains. Documentation of tympanic membrane integrity in otitis externa increased from 34.3% to 67.7%. Timely manipulation under anaesthesia (MUA) for nasal fracture improved from 92.9% to 100%. Audiogram performance within 24 hours for SSNHL rose from 33.3% to 80%, and appropriate cautery use in epistaxis increased from 87.2% to 98.1%. Reductions in unnecessary imaging and swabbing were also achieved. Staff survey responses indicated improved confidence, efficiency, and guideline accessibility.

Conclusions: A low-cost, user-designed digital toolkit meaningfully improved clinical quality, documentation, and practitioner confidence in ENT casualty practice. This model demonstrates scalability across acute specialities where junior-led care is common.