A multifaceted approach to improving the quality of ENT Emergency Clinic referrals

Abstract

It is imperative that primary care referrals are directed to the appropriate secondary care service. Patients presenting to a primary care physician with ENT conditions may require review in an Emergency Clinic. The latter clinics provide patients with rapid access to secondary care, for urgent, yet non-life-threatening conditions. In our department, we noticed that patients with conditions inappropriate to the capabilities of the Clinic were being booked in or reviewed too late; thus causing wasted journeys for the patient. We conducted a Quality Improvement Project to improve the efficiency of the referral process. A prospective evaluation of referrals was collected continuously over a two-month period. Overall, 5 domains were deemed crucial to enable timely and accurate booking of patients to clinic: booking date, urgency, legibility, patient identification and appropriateness. Our proposed standard set for this project was 100% compliance over the 5 domains. Three separate interventions were instigated following the first cycle. The main components of the intervention were the phased development of an electronic referral system and an educational initiative for junior doctors.20 referral forms were analysed during the initial 3-week period. No referrals met the recommended overall compliance standard of 100% (mean number of domains achieved: 3.38; standard deviation (SD): 0.637). Legibility and patient information were included in 21% and 30% of referrals, respectively. There was a trend of improvement following initiation of interventions. The mean number of domains achieved was 4.27 (SD 0.647; n=13) in the second data collection period, 4.53 (SD 0.514; n=16) in the third, and 4.75 (SD 0.452; n=24) in the fourth. Using linear regression, this change demonstrates a statistically significant improvement (p<0.001).An e-Proforma referral system represents a safe and efficient communication technology. When implementing policy change, it is crucial to acquire managerial and consultant support.

Evaluating the Appropriateness of ENT Emergency Clinic Referrals to Enhance the Quality of Healthcare Provision in the NHS

“…This notion is further supported by a review about service improvement in healthcare organization commending leadership interchange among professionals of various levels [10]. It stands to reason that directing cases to the appropriate healthcare professionals, such as senior specialist registrars or specialist nurses, could optimise the clinical workflow, potentially reducing referral backlogs and facilitating increased patient bookings [9]. Furthermore, addressing inappropriate referrals is crucial in ensuring efficient patient care.…”

“…This surge in routine cases strains resources unnecessarily, potentially impeding the clinic's ability to allocate resources effectively and provide optimal care to individuals in urgent need. Hence, striking a delicate balance between managing urgent cases and appropriately addressing routine cases becomes imperative to ensure an efficient and effective healthcare delivery system within the clinic [9]. Our primary goal was to scrutinize and assess the cases referred to the clinic, aligning them with clinical priorities.…”

Non‐systematic review: Correspondence quality and interoperability between family physicians and hospital clinicians

“…The first step to improve communication is having a clear guideline on the content of communications; unfortunately, as manual processing is inaccurate, to prevent cases like those described in the literature, 14,78,79 templates should be used as they improve documentation 41 ; a second step is improving interoperability, which should be easier following an agreement on what information and what format to follow, and in this respect the use of the same medical codes to facilitate the information processing. A third step should be adapting the basic information shared to accommodate additional information required, like for example for heart failure services the weight of the patient at discharge, 64 but it should be reciprocated, so both parties share the latest information, update it and in consequence a coordinated care results.…”

“…Previous systematic reviews on communication between primary and secondary care have shown issues such as general practitioners satisfaction, 75 secondary clinicians attitudes, 76 educational needs, 38,77 lack of standardisation, 75 benefits from information technology like templates, 77 information management 40 and timeliness. 76 Content has also been assessed, [75][76][77] but not been the focus as on this paper.…”

Lateral nasal wall abscess following manipulation of fractured nasal bones

“…In the UK, ENT casualty clinic is frequently led by senior house officers (SHOs), and thus, SHOs are often the responsible clinicians for assessing and listing patients for MUA. Likewise, the SHO may consent the patient for the procedure and should be aware of the relevant risks and adverse outcomes 6 7…”