Gloucestershire Hospitals NHS Foundation Trust, UK.
Ann R Coll Surg Engl. 2022 Feb;104(2):117-120. doi: 10.1308/rcsann.2021.0068. Epub 2021 Nov 23.
The ear, nose and throat (ENT) emergency clinic is managed by foundation year (FY) doctors from taking referrals to discharging patients, under the supervision of a registrar. FYs learn essential skills and knowledge on how to manage common ENT problems. The clinic is often overloaded because of a high patient demand, and this limits the opportunities for teaching. We hypothesised that the clinic bookings would be better managed if referrals from general practitioners (GPs) were triaged by registrars.
Telephone referrals from GPs for the ENT emergency clinic were directed to the on-call ENT registrar, between 8am and 1pm from Monday to Friday, and to the FY outside of this period. Consecutive referrals to the emergency clinic were analysed in a baseline audit and a post-intervention cycle.
A total of 646 and 611 patients were given clinic appointments in the first and second cycles, respectively. Clinic session overbookings decreased from 85% to 46.3%. Appointments for referrals that were deemed inappropriate had reduced from 22% to 12.1%.
Involvement of a registrar in taking referrals for the ENT emergency clinic was associated with a reduction in clinic overbookings. It is feasible and productive to involve a senior decision maker in the operational management of the emergency clinic, while preserving the delivery of this service by FYs for its training value.
耳鼻喉科（ENT）急诊诊所由住院医师管理，从接收转诊到患者出院，均在住院医师的监督下进行。住院医师在此过程中学习管理常见 ENT 问题的基本技能和知识。由于患者需求量大，诊所经常超负荷运转，这限制了教学机会。我们假设如果由主治医生（GP）对 ENT 急诊转诊进行分诊，那么诊所的预约管理将会得到改善。
周一至周五上午 8 点至下午 1 点期间，GP 对 ENT 急诊诊所的电话转诊将被转接到值班 ENT 主治医生，在此期间以外的时间则转接到住院医师。在基线审核和干预周期中，对连续到急诊诊所就诊的患者进行了分析。
在第一个和第二个周期中，分别有 646 名和 611 名患者获得了诊所预约。门诊预约超额预订从 85%减少到 46.3%。被认为不合适的转诊预约从 22%减少到 12.1%。
主治医生参与 ENT 急诊诊所的转诊与门诊预约超额预订的减少有关。在保留住院医师提供服务以实现其培训价值的同时，由高级决策者参与急诊诊所的运营管理是可行且富有成效的。
