Audit Cycle:
This is a closed-loop audit cycle beginning with the recognition of the problem and assessing the magnitude of the problem. The primary outcomes were the number of referrals to the minor operation theater (MOT) from ENT OPD of the [blinded] hospital of the cases presenting with ear problems that require only suctioning and moping for the management of ear discharge. The data of the initial audit were collected from ENT OPD from Dec 01, 2021, to Dec 30, 2021, and it included 300 patients. We recorded patients’ age, presenting complaints that required suctioning, diagnosis, and reasons for referral. Based on the burden of referrals to the MOT, the auditors proposed the changes in practice following hospital OPD guidelines enacted by Pakistan Otolaryngology Association. Local guidelines were constructed and the modifications were implemented for 1 month (Jan 01, 2022-Jan 30, 2022). Re-audit was performed on the collected data during the period and analyzed in IBM SPSS version 25. Re-audit included 300 patients and assessed whether there was any necessity for referral during the implementation of constructed guidelines. The audit cycle is illustrated in figure 1.