Ricard Simo is a Consultant Head and Neck Surgeon at Guy’s and St Thomas’s Hospital. He is also Vice-President of the European Laryngological Society and is the Audit and Governance Lead for the ENT-UK Head and Neck Society. Our editor, Declan Costello, caught up to discuss a world first: an online database of laryngeal surgery.
What was the prompt to set up the National Laryngeal Surgery Audit?
In the UK, participation in national-based audit is an essential part of appraisal and revalidation. Other associations such as the British Association of Endocrine and Thyroid Surgeons (BAETS) have established national registries and audits for a long time and it was thought that a national laryngeal registry would be an ideal next step. Laryngeal surgery is at the heart of our specialty and it is performed by generalists, laryngologists and head and neck surgeons. It has also a multidisciplinary element with participation of speech and language therapists, so it was felt to be ideal.
Who took the initiative of the audit?
Interestingly, two groups within the ENT-UK had the same idea almost at the same time, the ENT-UK Head and Neck Society and the British Laryngological Association. After some meetings and discussions it was agreed that the audit should be a joint one so it would help all ENT-UK Membership.
Has this been done elsewhere in the world?
No. This is, in fact, the first national, European and worldwide National Registry in laryngeal surgery. We are very proud that this is a completely innovative project.
You have succeeded in bringing together the needs of head and neck surgeons and benign laryngeal surgeons – was it difficult to find areas of common ground? Did both groups want the same things?
As I’ve indicated, laryngeal surgery is at the heart of the specialty and it’s important to teach it well at the beginning of the training. There is no doubt that benign laryngeal surgeons have a different perspective from head and neck surgeons but there was recognition that there was a lot of common ground.
Many databases are quite cumbersome, with lots of data to enter. How are you planning to avoid this?
Indeed. It has taken a lot of time and discussions to agree on what would be a reasonable minimum data set that would serve all spectrum of surgeons from district general hospitals to specialised voice clinics. It takes approximately three minutes to enter a set but only one minute to enter a follow-up. If you want to, it is possible to enter a large amount of very detailed information; but if you prefer to enter much less, that is also possible.
Who helped with the set up and the design, as well as the running of the database?
When we started, some of us were already contributing data to the BAETS national registry. We knew that Dendrite Clinical Systems had developed many registries nationally and internationally and we approached them. Peter Walton, who is the managing director of Dendrite has been very helpful and instrumental in making something that sounds terribly complicated into something that is easily manageable. They helped with setting the concept, the questions, data fields and the structure. They will also maintain the database and produce yearly reports.
How is the registry set up?
Essentially, the database follows a patient journey including demographic data, significant past medical history and co-morbidities, clinical symptoms, purpose of the surgery, details of the surgery which can be endolaryngeal such as microlaryngoscopies or open such as thyroplasties and laryngectomies. Then it goes to the discharge details including complications and the follow-up where you include the outcomes.
Which outcomes have you set up?
In order to keep this simple we have included three types of outcomes: complications, resolution of symptoms and voice. And again, to keep it simple and wide, the voice outcomes will be recorded using GRBAS (a perceptual measure) and the VHI-10 (a patient-reported outcome).
How will people register?
At present, they can write to me or directly to Peter Walton and register. In the coming months, it will be possible for surgeons to register via the ENT-UK website. It is anticipated that the front page of the ENT-UK website will have a field that allows registration and access.
When does it launch?
It is in fact live! It was officially launched in the ENT-UK Annual Meeting in September 2014 and it was really well received. We have now over 20 ENT surgeons participating and over 100 cases recorded in the space of two months.
How is it likely to change over time?
As with any audit, this is an evolutionary process. This is only the beginning, but there is a lot of work to be done. Initially, we had four surgeons testing the registry for three months: Julian McGlashan, you [Declan], Tony Aymat and myself. Based on feedback to Dendrite, we made significant changes to ensure that data was easy to enter. We are now entering a period of a year where we expect the membership who enters data, to feed back as to how they find it, what fields we should add and which ones may not be useful. In October 2015, we will produce the first report and we are hoping that this will provide some grounds to implement positive change.
Anything else you wish to add?
Well, as with any projects of such magnitude, this would not have been possible without the help and support of a lot of people. My thanks go to Valerie Lund, President of ENT-UK, Janet Wilson, President of BLA, David Howard, Past-President of BLA, and Nick Roland, President of the ENT-UK Head and Neck Society. To Julian McGlashan, you [Declan] and Tony Aymat who were instrumental in the set up of fields and the testing, and to Mark Watson, Meredydd Harries and Guri Sandu. From Dendrite, I would like to thank Peter Walton and Robin Kingsman and the whole of his team – without their help this would not have been possible.
National laryngeal surgery database key facts
For all forms of open and endoscopic laryngeal surgery
Collect your own data and compare against pooled data from colleagues around the world
Essential for appraisal and revalidation in the UK
Contact to register on the database email: email@example.com or firstname.lastname@example.org
Go-live date: NOW!
Interview conducted by Declan Costello.