Informed consent is an important aspect in patient care. Failings in this area may result in patient dissatisfaction or litigation. The aim of this project was to assess our practice in consenting and institute changes to maintain best practice. A consecutive series of 140 patients undergoing elective and trauma procedures were randomly identified over a nine-month period. The consent forms were reviewed and the following information collected: patient/ consenter details, procedure, legibility, if copy was offered/ given to patient and adequacy of procedure-specific complications listed (scored 0-3). The issues identified included: 25% of consents were not fully legible particularly in the complications section. 62% were noted to have inadequate complications listed (score 0 [>5 risks missing]) when compared to an accepted standard. None of the consent form copies were offered or given to the patients. Focused teaching to juniors as well as procedure-specific complication stickers were implemented to improve the documentation of complications. Following several improvement cycles all consents (100%) were fully legible and had the adequate procedure-specific labels with all complications listed. There was an increase to 38% of consent forms offered to patients. We have asked surgeons in the department to comment on which consent method they prefer and all consenters felt that the procedure-specific labels where easier to read and understand. Departmental education as well as introduction of simple procedure-specific complication stickers has resulted in significant improvements in practice.

BackgroundIn 2018, AJCC TNM staging changed for differentiated (DTC) and anaplastic (ATC) thyroid carcinoma. The impact of this change on mortality rates was investigated and compared with the MACIS prognostic score.MethodsAnalysis of a prospective database of DTC/ATC was undertaken. Patients were staged according to TNM7 and TNM8 criteria, and MACIS scores calculated. Five‐year disease‐specific mortality rates were determined. Proportions were compared with Fisher's exact and χ2 goodness‐of‐fit tests.ResultsBetween August 2002 and December 2016, 310 patients had primary surgery for thyroid cancer. After exclusions, 159 patients (154 DTC, 5 ATC) remained to be studied. The MACIS score was less than 6 in 105 patients (66·0 per cent), 6–6·99 in 19 (11·9 per cent), 7–7·99 in 14 (8·8 per cent) and 8 or more in 21 (13·2 per cent), with corresponding disease‐specific 5‐year mortality rates of 0, 5, 14 and 86 per cent. For TNM7 the distribution was stage I in 53·5 per cent (85 patients), stage II in 10·1 per cent (16), stage III in 14·5 per cent (23) and stage IV in 22·0 per cent (35), and differed from that for TNM8: 76·7 per cent (122), 10·7 per cent (17), 4·4 per cent (7) and 8·2 per cent (13) respectively (P < 0·001). Overall disease‐specific 5‐year mortality rates by stage for TNM7 versus TNM8 were: stage I, 0 of 85 versus 3 of 100 (P = 0·251); stage II, 0 of 16 versus 6 of 16 (P = 0·018); stage III, 3 of 23 versus 2 of 7 (P = 0·565); stage IV, 20 of 32 versus 11 of 11 (P = 0·020).ConclusionCompared with TNM7, TNM8 downstaged more patients to stage I and accurately reflected worse prognosis for stage IV disease. TNM8 is an inferior predictor of mortality compared with MACIS.

Introduction Numerous technological advances have been made during the COVID‐19 pandemic. There has been a growing body of evidence highlighting the value of virtual consultations as an adjunct to physical appointments. This study presents the virtual clinic experiences of one ENT department in the UK. Methods Retrospective review of all virtual consultations undertaken at a single ENT department during the COVID‐19 pandemic. Results A total of 556 virtual consultations took place during the study period across all ENT sub‐specialties. Of which 27% of patients were converted to face‐to‐face follow‐up and over 30% were discharged following a virtual consultation. Out of 333 video consultation, 31% were converted to telephone due to patient preference or technological difficulties. Conclusion This study highlights the benefits and lessons learnt from implementing a virtual clinic system in ENT. The authors recommend the introduction of video consultation as a useful adjunct to face‐to‐face appointments during the COVID‐19 pandemic and beyond. Level of Evidence 4.

Objectives: Barium studies are routinely requested to investigate a range of conditions, however, its efficacy for several conditions is unclear. Alongside findings from our audit in a district general hospital, we aim to review current literature on the use of barium swallow as an investigation for pharyngeal pouch, globus pharyngeus, tertiary peristalsis and oesophageal malignancy in adults. Methods: A systematic literature search was conducted on three databases for papers published in English in the last ten years. Following screening, six studies were included for pharyngeal pouch, five studies were included for globus pharyngeus, seven studies were included for tertiary peristalsis, and thirteen studies were included for oesophageal malignancy. Results: Barium swallow is a useful and important investigation in diagnosing pharyngeal pouch and can be useful to investigate oesophageal dysmotility in tertiary peristalsis. Globus pharyngeus patients do not clinically benefit from undergoing barium swallow. Oesophagogastroduodenoscopy (OGD) should remain as first line in diagnosing oesophageal malignancies. Conclusion: Barium swallow should be used to investigate pharyngeal pouch and tertiary peristalsis, but not used as the main investigation for globus pharyngeus or oesophageal malignancy. There is a need to develop further guidelines for investigations requested for dysphagia.