1

Introduction

Acute otolaryngologic complaints are common and range from ear pain and hearing loss to cases of severe epistaxis and airway compromise. According to the National Hospital Ambulatory Medical Care Survey, 2,361,000 patients were seen in an emergency room for otitis media and Eustachian tube disorders in 2010 alone . It is estimated that upwards of 10% of new consultations in primary care offices are related to ear, nose or throat disorders, many of which may require urgent evaluation and treatment . With the passage of the Patient Protection and Affordable Care Act, the number of insured Americans is expected to rise, resulting in a projected shortage of otolaryngologists . As a result, the burden of acute otolaryngologic care in both outpatient and standard emergency room practice settings will increase in the near future .

Traditional emergency rooms (ER) are saturated beyond their intended capacity, resulting in long wait times and potentially inferior outcomes . Dedicated otolaryngology-specific emergency rooms (ER) are largely uncommon in the United States and not well described in the otolaryngology literature. As a significant number of complaints seen in emergency departments are otolaryngologic in nature, an otolaryngology ER may theoretically relieve pressures of traditional ERs and improve patient outcomes by increasing access to specialist care . Otolaryngology ERs have been described in other countries, including, Greece, Spain, Israel, Brazil, France and India , and take the form of stand-alone emergency rooms , integrated units in hospital emergency departments , urgent care clinics , or full-time emergency services in a hospital . Otologic disorders represent a common indication for referral or utilization of a specialized otolaryngology ER in these previous reports. Some facilities manage a higher volume of trauma, foreign body, or epistaxis that require urgent treatment whereas others institutions describe care that is predominantly for patients with common otolaryngologic complaints such as otitis media, otitis externa and sinusitis .

At the Massachusetts Eye and Ear Infirmary (MEEI), a dedicated stand-alone otolaryngology emergency room (ER) provides specialty care to any patient with otolaryngologic complaints twenty four-hours per day, seven days per week, 365 days per year. This ER functions similarly to a standard ER, albeit on a smaller scale. Patients are frequently transferred from community-based emergency rooms without otolaryngologic coverage or outpatient clinics for acute otolaryngologic evaluation. A CT and magnetic resonance imaging scanner are available 24 hours per day, as well as audiologic evaluation by audiologists. Patients can be admitted to the MEEI otolaryngology inpatient service or can be triaged directly to the operating room in an expeditious fashion. The MEEI ER is adjacent and physically connected to the Massachusetts General Hospital (MGH) and patients with life-threatening illness or non-otolaryngologic complaints may be rapidly transferred directly to the MGH ER. Descriptive trends in the MEEI emergency room were last characterized 30 years ago as a short communication article .

There is no contemporary analysis of practice patterns or utilization trends for an otolaryngology ER in the United States. In the context of rising healthcare costs and new models of healthcare delivery, this study seeks to investigate a unique venue for acute otolaryngologic care. We aim to provide a comprehensive, descriptive analysis of patient demographics, visit characteristics and the range of otolaryngologic complaints in this unique acute care setting. This study can be viewed as a baseline evaluation and starting point of a discussion regarding acute otolaryngologic care in the United States.