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Objective: Payment by results was introduced to the UK National Health Service in 2004. Specific payment tariff for ENT departments is determined by clinical code of the patient's episode. Our aim was to review clinical coding in our department and assess scope for improving accuracy of coding and income tariffs. Method:We retrospectively reviewed coding of operations over a 4-month period. A database was obtained including primary operation code and payment tariff. Using a system that grouped operation codes according to anatomic site, we analyzed each case to see if actual code attributed to the procedure could be improved.Results: Over the 4-month period there were 930 operations; 866 (93%) were correctly coded with an optimal tariff, 19 (2%) were incorrectly coded giving an excessive total tariff of £24,840, and 45 (5%) were incorrectly coded losing a tariff of £37,381. Therefore, over the 4-month period, £12,541 was lost due to suboptimal coding. Conclusion:A system that groups ENT operation codes according to anatomic regions and procedure types efficiently aids the accuracy and optimization of income tariffs. It may be employed during the clinical coding process as a quality assurance tool.Objective: The Script Concordance Test (SCT) involves the use of authentic clinical scenarios to compare a medical trainee's judgment skills with those of experts. The aim of this work is to produce valid, reliable SCT for the ear, nose, and throat (ENT) discipline. Method:In total, 132 participants were asked to test an online ENT-SCT of 20 cases and 94 questions based on the major educational objectives of the ENT residency program. Three levels of experience were tested: medical students, ENT residents, and board-certified otorhinolaryngologists as an expert panel. Results:The 65 respondents with useable data were medical students (n = 21), ENT residents (n = 22), and experts (n = 22). Total mean test scores significantly differed: 76.81 ± 3.31 for the expert panel, 69.05 ± 4.35 for residents, and 58.29 ± 5.86 for students. The Cronbach alpha coefficient was 0.95. More than two-thirds of the participants found the test realistic and relevant for assessing clinical reasoning. The test was also considered interesting and intuitive. Conclusion:The web-based ENT-SCT is feasible, reliable, and useful for assessing clinical reasoning. This online assessment tool may have applications for residency programs and continuing medical education.

Objective: Ventilation tube insertion is the primary surgical intervention in persistent otitis media with effusion. Around 7% of ventilation tubes require elective removal. The objective is to discover the tympanic membrane healing rate after ventilation tube removal and identify measures that improve this. Method: Retrospective case note review performed for patients who had elective ventilation tube removed over an 8-year period. Information gathered included if any concomitant procedure was performed to repair the tympanic membrane and final outcome of the tympanic membrane status. Results: A total of 113 cases were included in this study. The average age at grommet insertion and removal was 5.8 years old and 8.3 years old, respectively. After ventilation tube removal the perforation edges were freshened in all cases. The majority of patients (84.1%) subsequently had an intact tympanic membrane. Additional procedures were performed on 19 ears, 6 with insertion of overlay absorbable material and 14 with a fat plug. Closure rate in these patients was 100%. Shah and Sheperd grommets had a significantly lower residual tympanic membrane perforation rate compared to T-Tube and Titanium grommets. Conclusion: Tympanic membrane closure rate after ventilation tube removal was 84.1%. Additional procedures, ie, overlaying of absorbable material, appear to improve the closure rate. We therefore advocate the technique. In selected cases such as T-tube removal a concurrent fat plug myringoplasty may be appropriate.