Running the clinic
Quality & research
A vertigo clinic that does not measure itself is a guess machine. The cheapest quality investment is also the highest-yield: the right metric collected every visit.
Quality assurance in the clinic does three things: it tells you whether your patients are getting better, it tells you whether your protocols are consistent, and it gives you the evidence to ask for more resources.
The minimum useful set is one patient-reported outcome measure (the DHI), one workflow metric (same-visit diagnosis rate) and one safety check (ED-redirect rate for missed central diagnoses).
The Dizziness Handicap Inventory (DHI) is the standard outcome instrument — 25 items, 0–100 scale, functional / emotional / physical sub-scales.1 Capture it at entry and three months; the change score is your single most useful clinic-level metric. Pair it with the Timed Up & Go for fall-risk patients.2
The modified Clinical Test of Sensory Interaction in Balance (CTSIB)3 is free, validated, and quick. It is an excellent rehab-progress tracker — measure it every fortnight during a rehab block.
Build a small registry from day one. Five fields per patient is enough to start: diagnosis, DHI on entry, DHI at 3 months, treatments offered, and any escalation event. This catches the workflow problem behind the charted-diagnosis / management-decision disconnect that drives much of the suboptimal vertigo care visible in national-survey data.4
Two quarterly meetings: an MDT clinical-governance meeting (case review, outliers, protocol updates) and a research / audit meeting (registry pull, the year's question, a presentation due). Quality and research are the same thing on different time scales.
Audit metrics
- DHI change at 3 months — primary patient-reported outcome.
- Same-visit diagnosis rate — target ≥70% for an established clinic.
- Time from referral to first visit — track per referral source.
- Epley first-attempt resolution rate — target ≥75% (peer benchmark).
- Imaging order rate — neuroimaging per new patient; compare with pre-clinic baseline.
- ED-redirect rate — patients referred from ED who are sent back; an under-recognised safety metric.
- Vestibular rehab uptake — fraction of indicated patients reaching the first physio visit.
- Patient experience — one survey question per visit ("would you recommend?") is enough.
Research integration
The registry doubles as a research backbone. Most service-redesign questions are answerable from existing audit data with minimal extra collection. Worthwhile single-clinic questions include the impact of standardising the Epley variant, the local prevalence of BPPV subtypes, and the conversion rate from PPPD to remission across the three-pillar treatment.
Apply for ethical approval once for the registry rather than per project; this collapses the lead time on subsequent studies and lets the clinic publish the kind of pragmatic service evidence that the field needs more of.