Background Healthcare provision remains challenging leading to a focus on health service redesign including the development of nurse‐led clinics. While there is a belief that nurse‐led services positively impact on healthcare delivery, it is necessary to inform development through examination of the evidence. Methods A search was conducted of Cumulative Index of Nursing and Allied Health Literature, MEDLINE, EMBASE, Scopus and the Cochrane Library for systematic reviews evaluating the effectiveness of nurse‐led clinics when compared with usual care published between 2015 and 2020. Outcomes of interest were clinical outcomes, patient satisfaction and patient access to health care. Study quality was appraised using the AMSTAR 2 tool (A MeaSurement tool to Assess Systematic Reviews). A narrative analysis was conducted. Results From 681 identified studies, nine were included, with reporting quality rated from very low to high quality. Patient clinical outcomes were reported as equal to or better than usual care across all studies included. There was evidence of high levels of patient satisfaction with nurse‐led clinics across the included systematic reviews. While access to health care was the least reported variable, there were reports that access to health care increased or patient reliance on other healthcare providers reduced due to nurse‐led clinics. Conclusions Despite the heterogeneous nature of the systematic reviews, along with some quality issues in reporting, there was evidence that nurse‐led services provided comparable or superior care to usual care with high levels of patient satisfaction. There was a lack of reporting on the impact of nurse‐led clinics on patient access to health care; further research is required on this area. Health service managers should consider nurse‐led clinics an effective innovation in health service provision.

Introduction Preoperative testing for COVID‐19 has become widely established to avoid inadvertent surgery on patients with COVID‐19 and prevent hospital outbreaks. Methods A prospective cross sectional study was carried out in two university hospitals examining the pre‐operative protocols for patients undergoing otolaryngology surgery and the incidence of COVID‐19 within 30 days of surgery in patients and the otolaryngologists performing surgery. Results One hundred and seventy‐three patients were recruited. One hundred and twenty‐three (71%) patients “cocooned” for 14 days prior to surgery. All completed a questionnaire prior to admission. One hundred and fifty‐six patients (90%) had reverse transcriptase‐polymerase chain reaction (RT‐PCR) nasopharyngeal swabs, 14 patients (8%) had CT thorax. No cases of COVID‐19 were detected among patients followed up at 30 days. Two surgeons developed COVID‐19 early during the study period. Conclusion Current pre‐operative testing protocols consisting primarily of questionnaires and RT‐PCR resulted in zero cases of COVID in this cohort. It is possible that COVID‐19 restrictions and high proportion of patients cocooning preoperatively were factors in ensuring a low rate of COVID‐19 post‐operatively.

Background Concerns have emerged regarding infection transmission during flexible nasoendoscopy. Methods Information was gathered prospectively on flexible nasoendoscopy procedures performed between March and June 2020. Patients and healthcare workers were followed up to assess for coronavirus disease 2019 development. One-sided 97.5 per cent Poisson confidence intervals were calculated for upper limits of risk where zero events were observed. Results A total of 286 patients were recruited. The most common indication for flexible nasoendoscopy was investigation of ‘red flag’ symptoms (67 per cent). Forty-seven patients (16 per cent, 95 per cent confidence interval = 13–21 per cent) had suspicious findings on flexible nasoendoscopy requiring further investigation. Twenty patients (7.1 per cent, 95 per cent confidence interval = 4.4–11 per cent) had new cancer diagnoses. Zero coronavirus disease 2019 infections were recorded in the 273 patients. No. 27 endoscopists (the doctors and nurses who carried out the procedures) were followed up.The risk of developing coronavirus disease 2019 after flexible nasoendoscopy was determined to be 0–1.3 per cent. Conclusion The risk of coronavirus disease 2019 transmission associated with performing flexible nasoendoscopy in asymptomatic patients, while using appropriate personal protective equipment, is very low. Additional data are required to confirm these findings in the setting of further disease surges.

Objective: Preoperative testing for COVID-19 has become widely established to avoid inadvertent surgery on patients with COVID-19 and prevent hospital outbreaks, however, there is limited evidence underpinning new protocols. We wished to study the effectiveness of preoperative COVID-19 testing during and after the first wave of the pandemic in Ireland. Design Prospective cohort study. Setting: 2 university hospitals in the Republic of Ireland. Participants: Patients undergoing otolaryngology surgery and the otolaryngologists performing surgery. Main outcome measure: Incidence of COVID-19 within 30 days of surgery. Results: 173 patients (56% male) were recruited. 123 (71%) patients “cocooned” for 14 days prior to surgery. All patients completed a questionnaire prior to hospital admission. 156 patients (90%) had reverse transcriptase-polymerase chain reaction (RTPCR) nasopharyngeal swabs, 14 patients (8%) had CT thorax. No cases of COVID-19 were detected among patients followed up at 30 days. Two surgeons developed COVID-19 early during the study period not considered to be related directly to contact within the hospital. Conclusion: Current pre-operative testing protocols consisting primarily of questionnaires and RT-PCR resulted in zero cases of COVID reported in this cohort. It is possible that COVID-19 restrictions and high proportion of patients cocooning preoperatively were factors in ensuring a low rate of COVID-19 postoperatively. Ongoing data collection is required to confirm these findings in the setting of further disease surges.