Aim
To assess the effectiveness of medical or
surgical treatment in patients with sino-nasal
disease who present to ENT outpatient
clinics
Method

Forms collected between 1st September 2013 - 24th December
2013 (some forms were dated outwith these periods)

Patients complete SNOT questionnaire prior to consultation

Consultant completes clinical information on form

Data from forms recorded on an Excel spreadsheet

Paper copies filed alphabetically for each consultant

Incomplete forms filed separately

Sources of SNOT scores for the audit were:
 SNOT forms collected in this audit cycle
 Previously filed forms
 SCI-store letters
What is the SNOT Questionnaire?
 A patient-reported measure of outcome in
treatment of sino-nasal disorders
 The SNOT questionnaire contains 20 questions
 The first half of the questionnaire relates to
physical symptoms – nasal, ear, and facial
symptoms
 The second half relates to quality of life (sleep
and psychological issues)
http://www.entnet.org/research/outcomes/browne%202007.pdf health related quality of life
Results
404 forms returned
 126 forms were able to be used in the audit (criteria for
inclusion: Name, CHI, diagnosis, treatment, pre/post, and at
least one SNOT score)


278 forms excluded from this audit cycle:
 Only pre-treatment score available at present (166)
 Discharged after 1st appointment (8)
 DNA 2nd appointment (3)
 Non sino-nasal disease (2)
 Only post-treatment score available (31)
 Forms missing name, diagnosis or treatment (68)
Surgeon A
Number
of Cases
Average
pretreatment
SNOT score
Average
posttreatment
SNOT score
Average
improvement
in SNOT score
Number
of
patients
improved
MEDICAL TREATMENT
36
50
44
6
23 (64%)
FESS + REVISION FESS
6
46
8
38
5 (83%)
FESS + SEPTOPLASTY
1
22
8
14
1 (100%)
SEPTOPLASTY +/INFERIOR TURBINATE
REDUCTION
7
34
14
20
6 (86%)
SEPTORHINOPLASTY
1
61
54
7
1 (100%)
Total
51
Surgeon B
Number
of Cases
Average
pretreatment
SNOT score
Average
Average
Number of
postimprovement patients
treatment in SNOT score improved
SNOT score
MEDICAL TREATMENT
25
45
31
14
13 (52%)
FESS + REVISION FESS
13
43
16
27
14 (93%)
FESS + SEPTOPLASTY
4
44
16
28
4 (100%)
SEPTORHINOPLASTY
5
36
13
23
4 (80%)
Total Cases
47
Surgeon C
Number
of Cases
Average
pretreatment
SNOT score
Average
posttreatment
SNOT score
Average
Number of
improvement patients
in SNOT
improved
score
MEDICAL TREATMENT
15
35
27
8
12 (80%)
FESS + REVISION FESS
3
41
26
15
3 (100%)
SEPTORHINOPLASTY
10
39
19
20
9 (90%)
Total Cases
28
Results
Number
of Patients
Patients with
Improvement
in Symptoms
Patients with
Worsening of
symptoms
Symptoms
Unchanged
MEDICAL TREATMENT
76
51 (67%)
21 (28%)
4 (5%)
FESS + REVISION FESS
22
21 (96%)
0 (0%)
1 (4%)
FESS + SEPTOPLASTY
5
0 (0%)
0 (0%)
SEPTOPLASTY +/- INFERIOR
TURBINATE REDUCTION
7
6 (86%)
1 (14%)
0 (0%)
SEPTORHINOPLASTY
16
14 (88%)
2 (12%)
0 (0%)
Total number of Patients
126
5 (100%)
What Went Wrong?
 SNOT forms still not being completed fully
 31 post-treatment SNOT forms did not have a
pre-treatment form/score recorded on the form,
available from the previously filed forms, or on
SCI-store
 There is not a reliable way to hand over the audit
data to the next group of doctors
Suggestions For Improvement
 SNOT scores could be recorded in the patient
notes at clinic appointments, enabling them to
be easily located at the next appointment, and so
written on the next SNOT form
 If SNOT scores were recorded in all dictated
letters, this would provide an easily accessible
record of the score should the SNOT form not be
fully completed in clinic