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Patient Advocates for UH Otolaryngology


Nurse practitioners play a key role in enhancing patient care and improving outcomes

Innovations in Ear, Nose & Throat - Winter 2019

First available.

Dina Cirino, CNP Dina Cirino, MSN, RN, CPNP-AC

It is the rallying cry schedulers hear on the other end of calls. Whether seeking treatment for themselves, a child or an aging parent, healthcare consumers want timely access to expert clinicians. In response, nurse practitioners at University Hospitals Ear, Nose & Throat Institute are working alongside physicians to offer coordinated care that is putting patients first, generating excellent outcomes and improving satisfaction rates.

Nationally, studies show that patients struggle to book prompt office visits. A 2016 analysis of 4.2 million first appointments found that wait times for high-demand specialties averaged 2.7 weeks1 — a lengthy delay for a fussy baby with recurrent ear infections or an elderly stroke survivor with a swallowing disorder. Fortunately, five UH otolaryngology nurse practitioners are dedicated to getting patients in the door for diagnosis, treatment and referral to needed services. 

“Our ENT model at University Hospitals is unique because we run side-by-side clinics with our surgeons,” says Dina Cirino, MSN, RN, CPNP-AC, a pediatric nurse practitioner within the UH Ear, Nose & Throat Institute. “We have a cohesive, collaborative practice that enables us to work as a team while maintaining autonomy to provide competent, patient-centered care.”


After extensive specialized training and proctoring, otolaryngology nurse practitioners have privileges to offer a wide range of services, including:

  • Inpatient care or ambulatory appointments
  • Patient and caregiver education
  • Pre-op workup and preparation
  • Post-op follow-up care 
  • Medication prescription and renewal
  • Flexible laryngoscopy
  • Debridement of sinuses, ears
  • Suture and drain removals
  • Foreign body removals
  • Nasal cautery
  • Head and neck oncology support
  • Specialty care for hearing loss, sleep apnea, breathing difficulties, cleft lip/palate, craniofacial disorders and management of other acute and chronic ENT concerns

In addition to increasing access to appointments, nurse practitioners play a key role in treatment planning with referring primary care providers, ENT specialists and colleagues in speech therapy, audiology, radiology and oncology. The result is that patients in need are connected to the testing and procedures they require with reduced wait time. In fact, if a patient workup determines that he or she is an appropriate candidate for surgery, nurse practitioners can expedite the process and often enable the patient to meet with the surgeon during their initial office visit.

“We advocate for our patients and follow them closely,” Cirino says. “Our nursing discipline provides a unique perspective that is centered on a holistic approach to care for each patient and family.” 


The team of nurse practitioners working within ENT includes two providers who treat pediatric patients, one specializing in otology, one focused on general adult otolaryngology and one dedicated to head and neck care. They see an average of 30 patients per clinic day and attend specialty ENT and multidisciplinary clinics, which streamline service delivery by providing a central location for patients to meet.

With responsibility for budgets and revenue benchmarks, UH nurse practitioners are highly productive and require fewer overhead resources than their surgeon counterparts. An analysis of performance indicators for 2018 shows that UH ENT nurse practitioners generated over $413 thousand in gross charges and achieved a work RVU (relative value unit) percentile of 84.9.

Additionally, the nurse practitioners’ ability to screen and fast-track appropriate surgical candidates, as well of their knowledge of surgeons’ schedules and openings, enables them to optimize surgical censuses. 


As integral care providers, ENT nurse practitioners exemplify the UH core values of teamwork and compassion. 

“We receive such positive feedback because we are able to get patients in quickly and provide the quality care they need,” Cirino says. “It is rewarding to know that we are making a difference for our community.”

1. Hayhurst, Chris. The doctor will see you…sometime. Athena Insight, December 11, 2017. www.athenahealth.com/insight/doctor-will-see-you-sometime.