अमूर्त
Top-quality: Improvement of the ENT emergency clinic service
Henry Dunne
Introduction: The Covid-19 pandemic and associated need for admission avoidance highlights the importance of an effective ENT emergency (EMENT) service1,2. This quality improvement project provided a holistic review of the Addenbrooke’s EMENT clinicand had the following aims:
To reduce inappropriate referrals.
To streamline referral pathways.
To increase capacity for new referrals.
To improve training of junior doctors.
Methods: A baseline audit of the EMENT clinic was conducted over 3 weeks from October-November 2020. A department wide staff survey covering clinic logistics, referrals, teaching, equipment, follow-upand sustainability was conducted.
Baseline results were presented at a departmental meeting. Agreed interventions introduced included:
An online GP referral proforma.
A registrar clinic supervision rota.
Guidance for follow-up of epistaxis and otitis externa.
Availability of a teaching microscope.
A second 3-week audit was conducted in June-July 2021.
Results: Following the interventions: The proportion of inappropriate GP referrals was reduced from 32% to 17%. The mean time till appointment was 6.5days when the proforma was used and 11.5days when it was not. The mean number of new patients seen per clinic increased from 3.5 to 5.3 The proportion of patients booked for follow-up into the EMENT clinic decreased from 38% to 22%. The proportion of patients offered patient-initiated-follow-up increased from 3% to 6%. Junior doctors reported greater satisfaction.
Discussion: Online referrals systems increase quality of referral requests3; our simplified primary-care referral proforma led to reduced inappropriate referrals. More complex patients that required emergency outpatient review could be accommodated due to dedicated registrar supervision which also helped to increase capacity of the clinic, to provide training experiences for juniors and to rationalise follow-up plans. Together these improvements support Addenbrooke’s Covid-19 efforts by diverting patients from elective clinics and aiding admission avoidance.