Mahalingam Sridhayan, Seymour Nicola, Pepper Christopher, Tostevin Philippa, Oakeshott Pippa
Department of Population Health Sciences and Education, St George's University of London, Cranmer Terrace, London, SW17 0RE, Department of Otolaryngology, Head and Neck Surgery, St George's Hospital, Blackshaw Road, London, SW17 0QT;, Email:
Department of Otolaryngology, Head and Neck Surgery, St George's Hospital, Blackshaw Road, London, SW17 0QT.
Qual Prim Care. 2014;22(5):251-5.
In the current financial climate faced by the NHS, it is important that we reduce the amount of inappropriate referrals made to secondary care specialties. ENT Emergency Clinics are one-stop clinics provided by many UK ENT departments to allow more rapid access to ENT services from primary care. However, many referrals to these clinics were considered to be inappropriate, overloading the clinic and delaying referrals to more specialist clinics. We conducted a service improvement project through introduction of referral guidelines and liaising with local GPs.
We carried out an initial audit of ENT referrals over a one-month period, which suggested that 31% (69/225) of referrals were inappropriate. We developed a guideline referral proforma that included six specific conditions and details of subspecialist clinics available. This was circulated among GPs and A&E doctors and backed up by hospital teaching sessions. Two months later we repeated the audit.
Following introduction of guidelines there was a significant reduction in inappropriate referrals from 31% (69/225) to 16% (28/179), p<0.01. Despite significant improvements overall, the proportion of inappropriate referrals from GPs remained higher than those from the local A&E department in both Cycle 1 (42% vs.24%, p<0.01) and Cycle 2 (23% vs. 5%, p<0.01).
Devising and circulating guideline proformas in conjunction with local education for referring doctors may help reduce the number of inappropriate ENT referrals. This simple and cheap intervention could be used more widely and developed in primary care departments in partnership with local hospitals. Our study also highlights the challenges encountered when introducing new guidelines that affect referrals from doctors in the community. Increasing opportunities for GP trainees to gain some exposure to common conditions presenting to primary care might reduce inappropriate ENT referrals in the future.
在英国国家医疗服务体系（NHS）当前面临的财政状况下，减少转介至二级医疗专科的不适当转诊数量非常重要。耳鼻喉科急诊诊所是英国许多耳鼻喉科部门提供的一站式诊所，以便让初级医疗能够更快速地获得耳鼻喉科服务。然而，许多转诊至这些诊所的病例被认为是不适当的，这使诊所不堪重负，并延误了转诊至更专科诊所的时间。我们通过引入转诊指南并与当地全科医生（GP）联络开展了一项服务改进项目。
我们对一个月内的耳鼻喉科转诊进行了初步审核，结果表明31%（69/225）的转诊是不适当的。我们制定了一份转诊指南表格，其中包括六种特定病症以及可用的亚专科诊所详情。该表格在全科医生和急诊医生中传阅，并通过医院教学课程提供支持。两个月后我们重复了审核。
引入指南后，不适当转诊显著减少，从31%（69/225）降至16%（28/179），p<0.01。尽管总体有显著改善，但在第1轮（42%对24%，p<0.01）和第2轮（23%对5%，p<0.01）中，全科医生的不适当转诊比例仍高于当地急诊部门。
结合对转诊医生的当地教育制定并分发指南表格可能有助于减少不适当的耳鼻喉科转诊数量。这种简单且低成本的干预措施可更广泛地应用，并与当地医院合作在初级医疗部门进一步发展。我们的研究还凸显了在引入影响社区医生转诊的新指南时遇到的挑战。增加全科医生培训学员接触初级医疗中常见病症的机会，未来可能会减少不适当的耳鼻喉科转诊。
