title: Consultant-led, multidisciplinary balance clinic: process evaluation of a specialist model of care in a district general hospital.
abstract: OBJECTIVE
  A specialist balance clinic to effectively deal with dizzy patients is recommended by ENT-UK. We audit the patient pathway before and following the introduction of a consultant-led dedicated balance clinic.
  
  
  METHODS
  Process evaluation and audit.
  
  
  METHODS
  ENT outpatients department of a district general hospital.
  
  
  METHODS
  The journey of dizzy patients seen in the general ENT clinic was mapped from case notes and recorded retrospectively. A consultant-led, multidisciplinary balance clinic involving an otologist, a senior audiologist and a neurophysiotherapist was then set up, and the journey was prospectively recorded and compared with that before the change.
  
  
  RESULTS
  Of the 44 dizzy patients seen in the general clinic, 41% had further follow-up consultations; 64% were given definitive or provisional diagnoses; 75% were discharged without a management plan. Oculomotor examination was not systematically performed. The mean interval between Visits 1 and 2 was 8.4 weeks and the mean number of visits was 3. In the consultant-led dedicated balance clinic, following Visit 1, only 8% of patients required follow-up; 97% received definitive diagnoses, which guided management; all patients left with definitive management plans in place. In all patients, oculomotor assessment was systematically performed and all patients received consultant and, where necessary, allied healthcare professional input.
  
  
  CONCLUSIONS
  By standardising the management experience for dizzy patients, appropriate and timely treatment can be achieved, allowing for a more seamless and efficient patient journey from referral to treatment. A multidisciplinary balance clinic led by a consultant otologist is the ideal way to achieve this.
authors.affiliation: Ipswich General Hospital, Heath Rd, Ipswich, UK.
authors.forename: A
authors.initials: A
authors.lastname: Trinidade
authors.forename: M W
authors.initials: MW
authors.lastname: Yung
mesh_terms: D003253:Consultants; D019468:Disease Management; D006311:Hearing Disorders / Q000628:therapy*; D006769:Hospitals, General / Q000458:organization & administration*; D006801:Humans; D008330:Management Audit; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D006113:United Kingdom