O'Neill Eunan, Gallagher Jennifer E, Kendall Nick
NHS South West London Croydon Borough Team, Public Health Directorate, Croydon, UK. eunan.o'
Prim Dent Care. 2012 Jan;19(1):23-8. doi: 10.1308/135576112798990728.
Patients attending for primary dental care may require oral surgery procedures beyond the capability of a generalist and thus need to be treated by a dentist with greater expertise. In the United Kingdom, it is increasingly accepted that such care may be provided in primary care settings by specialists or dentists with a special interest. In response to local pressures, an intermediate minor oral surgery (IMOS) service has been established in Croydon, south west London, to provide oral surgery treatment for non-urgent patients on referral.
To audit the appropriateness and quality of oral surgery referrals after triage to an IMOS service in Croydon and to set standards for future audits on this topic.
An audit tool was developed in line with the local referral guidelines and agreed with local stakeholders. Information on 501 (10%) triaged referrals to IMOS practices over a 24-month period was obtained through the referral management centre. A 10% sample of referrals per month to each practice was calculated and IMOS providers randomly selected the relevant patient records. Using an agreed audit pro forma, information on the indications for referral, treatment provided, and dates relating to patient management, in addition to the age and sex of patients, was collected from the IMOS providers by one investigator. Descriptive analysis of the data was performed.
Of the 501 patient records that were examined, 99% of patients were treated in IMOS practices, with only three (less than 1%) patients being referred on to hospital consultant services. The largest proportion (237; 40%) of referrals was for the extraction of teeth considered to have special difficulty, followed by lower third molars (154; 26%). Almost one-third (159; 32%) of patients were referred for more than one procedure. One in eight (72; 13%) teeth removed by the IMOS providers were recorded as a simple extraction without medical complications.
In general, patients were referred appropriately to the primary care oral surgery service in Croydon, with only a minority recorded as receiving simple care that should not have required referral. The clinician-led triage process using a referral management system worked well in selecting appropriate patients for treatment by IMOS providers in primary care and reduced referrals to hospital. Suggested standards for future audits of IMOS referrals have been set.
接受初级牙科护理的患者可能需要进行超出全科牙医能力范围的口腔外科手术，因此需要由更具专业知识的牙医进行治疗。在英国，越来越多的人认为，这种护理可以由专科医生或有特殊兴趣的牙医在初级护理机构提供。为应对当地压力，伦敦西南部克罗伊登市设立了一项中级小型口腔外科（IMOS）服务，为经转诊的非紧急患者提供口腔外科治疗。
审核分诊后转诊至克罗伊登市IMOS服务的口腔外科转诊的适宜性和质量，并为今后该主题的审核制定标准。
根据当地转诊指南开发了一种审核工具，并与当地利益相关者达成一致。通过转诊管理中心获取了24个月内501例（10%）分诊后转诊至IMOS诊所的信息。计算出每月每家诊所转诊病例的10%作为样本，IMOS服务提供者随机选择相关患者记录。一名调查员使用商定的审核表格，从IMOS服务提供者处收集了关于转诊指征、所提供治疗、与患者管理相关日期的信息，以及患者的年龄和性别。对数据进行了描述性分析。
在检查的501份患者记录中，99%的患者在IMOS诊所接受了治疗，只有3名（不到1%）患者被转诊至医院顾问服务。转诊病例中最大比例（237例；40%）是为了拔除被认为有特殊难度的牙齿，其次是下颌第三磨牙（154例；26%）。近三分之一（159例；32%）的患者被转诊进行不止一项手术。IMOS服务提供者拔除的牙齿中有八分之一（72颗；13%）被记录为简单拔牙且无医疗并发症。
总体而言，患者被适当地转诊至克罗伊登市的初级护理口腔外科服务，只有少数记录显示接受了本不应需要转诊的简单护理。使用转诊管理系统的临床医生主导的分诊流程在为初级护理中的IMOS服务提供者选择合适的治疗患者方面效果良好，并减少了转诊至医院的情况。已为今后IMOS转诊审核设定了建议标准。
