People wait longer than clinically recommended for specialist outpatient assessment in the public health system. 1 Governments are focused on redesigning service delivery, aiming to provide more flexible and patient-focused services, whilst increasing access to high-value care, at acceptably low costs. 2 Optimising and extending allied health practitioner (AHP) scope of practice can provide a responsive workforce whilst maintaining safe and quality health care. 3 Expanded roles for AHPs have gained popularity over the last decade, however, are not widely accepted as a sustainable alternative to the medical-led outpatient service model. 4

Background: Dizziness and vertigo are common referrals to Ear Nose Throat (ENT) outpatient services however these services have long waitlists for assessment. While a primary contact physiotherapy-led vestibular clinics is recognized at improving access to care, no published literature has reported on the safety and diagnostic accuracy of such a service. This study investigates diagnostic and management agreement between physiotherapists and ENT specialist for patients attending a primary contact physiotherapy-led vestibular clinic. Methods: Prospective blinded inter-rater agreement study undertaken in an ENT primary contact physiotherapy-led vestibular clinic. Participants included adults referred to ENT from general practitioners, triaged (Category 2 or 3) to the primary contact physiotherapy-led vestibular clinic with clinical symptoms consistent with vestibular disorder. Primary outcome measures included diagnoses and management decisions (imaging, ENT/ neurology/ physiotherapy management). Adverse events were reviewed 11 months post data collection. Percentage agreement and Gwet’s first order agreement co-efficient (AC1) calculated inter-rater reliability between physiotherapy and ENT. Results: Fifty-one participants were recruited consecutively from the primary contact physiotherapy-led vestibular clinic. Physiotherapy and ENT had a 78% agreement on categorised diagnosis. Agreements between physiotherapy and ENT for recommending Magnetic resonance imaging was 86%, and 94% for computorised tomography. There was moderate to near-perfect agreement regarding management recommendations between physiotherapy and ENT. An 82% agreement was found for recommendations to ENT, 94% for neurology and 73% for physiotherapy. There were no adverse events from physiotherapist’s management decision, based on final recommendations undertaken 11-months post data collection. Conclusions: Physiotherapists and ENT made comparable diagnostic and management decisions, based on physiotherapy assessment, for adults with signs of vestibular dysfunction, within an ENT primary contact physiotherapy-led vestibular clinic. This provides reassurance about the competency and safety of vestibular physiotherapists in the management of patients with dizziness.

Background Ear, Nose and Throat (ENT) primary contact models of care use audiologists as the first triage point for children referred to ENT for middle ear and hearing concerns; and have shown reduced waiting time, improved ENT surgical conversion rates and increased service capacity. This study aimed to investigate ‘safety and quality’ of the model by looking at agreement between audiologists’ and an ENT’s clinical decisions.  Methods We performed an inter-rater agreement study on diagnosis and management decisions made by audiologists and an ENT for 50 children seen in an Australian hospital’s ENT primary contact service, and examined the nature and patterns of disagreements. Results Professionals agreed on at least one site-of-lesion diagnosis for all children (100%) and on the primary management for 74% (Gwet’s AC1 = 0.67). Management disagreements clustered around i) providing ‘watchful waiting’ versus sooner medical opinion (18%), and ii) providing monitoring versus discharge for children with no current symptoms (8%). There were no cases where the audiologist recommended discharge when the ENT recommended further medical opinion. Conclusions Our novel research provides further evidence that Audiologist-led primary contact models for children with middle ear and hearing concerns are safe as well as efficient.