Helping nurses in the community diagnose and treat nasal blockages using a smart nose camera

Diagnosing nasal blockages generally sits within secondary care due to the tools and expertise needed. This can result in longer wait times for ear, nose and throat (ENT) patients and put pressure on the workforce.

Around 70% of ENT patients do not need surgery but instead could be medically treated within their community.

COVID-19 has exacerbated these pressures. Services were paused and new personal protective equipment measures caused waiting lists to increase.

Situation

University College London Hospitals NHS Foundation Trust (UCLH) wanted to relieve the pressure on secondary care and reduce waiting times for ENT patients.

Diagnosing nasal blockages happened in secondary care because there were no alternatives to the nasal endoscope or enough trained and experienced clinicians.

The majority of cases were referred to secondary care but only 30% needed surgical intervention.

Aspiration

The use of smart nose camera aims to empower primary care clinical specialists to diagnose nasal blockages, leaving secondary ENT services to focus on surgical interventions. This will reduce patient wait times and increase early diagnosis.

The team performed a pilot study in a community setting to determine effectiveness.

Key aims were to:

• reduce secondary care nasal blockage referrals by 80% over 24 months
• reduce backlog in the community by hiring 25% more healthcare professionals over 24 months
• identify opportunities to bring ENT diagnostic capabilities to a primary care setting led by a nurse specialist or physician associate
• deliver the initial diagnosis within a community or primary setting as a pilot study following the same infrastructure as TympaHealth

UCLH also wanted to explore opportunities for digitising the ENT diagnostic process. This included:

• capturing images
• providing digital communication, advice and guidance
• developing an app to aid interpretation of endoscopic findings

Solution and impact

UCLH collaborated with TympaHealth to create a smart nose camera which can be used by primary care clinicians to diagnose nasal blockages.

All images and videos taken by the device are stored on a secure cloud-based system which is compliant with the digital technology assessment criteria.

Through the TympaHealth remote review panel, specialists can review assessments and provide advice and guidance to the primary care clinician.

The advice and guidance given is the basis for machine learning and data analysis. TympaHealth and UCLH are collaborating on this.

Functionality

The smart nose camera:

• records patient history
• captures images and video of both nasal cavities during inspiration and expiration
• securely stores images and videos through the cloud
• remotely connects patients remote connectivity to rhinology specialists
• delivers reports as a PDF with history, images and videos which can be uploaded to the patient record
• can annotate images and videos with ‘normal’ or ‘biopsy’ labels and generate a PDF

Only simple training is needed to operate the smart nose camera, no other support is needed.

Capabilities

Alongside the smart nose camera, TympaHealth has an online software platform that can:

• interpret findings and predict potential treatments
• take patient history through a simple questionnaire
• produce activity reports on topics like number of examinations
• monitor trends over time to help manage disease progression
• measure successful disease treatment
• create advice and guidance requests on behalf of community or primary to secondary care
• examine the nose in a way that’s pain-free, non-invasive and doesn’t need aerosol
• share images and videos using a link

The smart nose camera also empowers patients to understand their condition.

After an examination, patients can watch the video or view images while a healthcare professional talks them through it. This helps to explain the examination and discuss options available. It supports and empowers patients to be more involved in their care.

Scope

The smart nose cam is used in primary and community settings by a clinician.

The device can be used offline but needs to be connected to the internet to upload photos, videos or both, to the cloud.

Key learning points

Throughout the project, it was key to engage the right stakeholders at the right time. This included:

• understanding user needs through patient groups and primary care engagement
• engaging with clinical commissioning group leads and operational stakeholders

Through a new rhinology pathway, it was vital to increase healthcare professionals’ understanding and trust that the smart camera was safe and effective at targeting bottlenecks and pain points.

Key figures

• The service has won the ENT UK’s Best Young Consultant Led Research, Audit or Training prize 2020 to 2021
• The service won Royal Society of Medicine Mr N Shah ENT Innovation Award 2020.
• Tympa System has won multiple global awards from the UX Design Awards, iF Design Awards and Good Design Awards.

Key contact

Peter Andrews, Senior Consultant Surgeon in Rhinology and Facial Plastic Surgery, UCLH

peterandrews@nhs.net

Krishan Ramdoo, CEO and Founder, Tympa Health Technologies

krishan@tympahealth.com