A pilot of artificial intelligence telephone triage of patients with suspected head and neck cancer (preprint)

1. The overwhelming majority of patients referred into secondary care with suspected head and neck cancer (HNC) do not have cancer (~95%). 2. During the COVID-19 pandemic telephone triage of patients with suspected HNC was necessary. During this time, a validated HNC risk-calculator, HaNC-RC-v2 (a set of symptomatology-based questions) was recommended by ENT UK to stratify patients into high or low risk of having HNC via telephone triage [(1)](#ref-0001) 3. Ufonia, a digital health company which uses an Artificial Intelligence (AI) voice assistant to automate clinical conversations via telephone, and *INSTITUTION*, were awarded an SBRI Healthcare grant to help develop an AI-delivered HNC triage telephone call. This was based on the HaNC-RC-v2 and co-created with HNC patients from the Heads2Gether charity via round-table discussions and one-to-one sessions. 4. Twenty-nine patients underwent a clinician-supervised AI-delivered HNC triage conversation as part of their standard telephone consultation. 100% of calls were completed with an average agreement of 89% between the clinician and the AI system for all symptoms asked. The technology was highly acceptable to patients with a median net promoter score (NPS) score of 8 out of 10. 5. Novel technologies involving AI automated telephone calls can be generated to remotely triage suspected HNC patients. This technology may offer an exciting opportunity to help departments triage suspected HNC referrals in an ever increasingly resource pressurised NHS.

Safety of day-case endoscopic sinus surgery in England: An observational study using an administrative dataset (preprint)

Background: As elective surgical services recover from the COVID-19 pandemic a movement towards day-case surgery may reduce waiting lists. However, evidence is needed to show that day-case surgery is safe for many ENT operations including endoscopic sinus surgery (ESS). We aimed to investigate the safety of ESS in England. Methods: This was an observational, secondary analysis of administrative data. Participants were all patients in England undergoing elective ESS procedure aged ≥ 17 years during for the five years from 1st April 2014 to 31st March 2019. The exposure variable was day-case or overnight stay. The primary outcome was emergency readmission within 30 days post-discharge. Results: Data were available for 49,223 patients operated on across 129 NHS hospital trusts. In trusts operating on more than 50 patients in the study period, rates of day-case surgery varied from 100% to 20.6%. Rates of day-case surgery increased from 64.0% in 2014/15 to 78.7% in 2018/19. Day-case patients had lower rates of 30-day emergency readmission (odds ratio 0.71, 95% confidence interval 0.62 to 0.81). For secondary outcomes measures, there was no evidence of poorer outcomes for day-case patients. Outcomes for patients operated on in trusts with ≥80% day-case rates compared to patients operated on in trusts with <50% rates of day-case surgery were similar. Conclusions: ESS can safely be performed as day-case surgery at current rates. There is a potential to increase rates of day-case ESS in England, especially in departments that currently have low rates of day-case ESS.