ENT open access clinic: an audit of a new service

Senior triaging of ENT emergency clinic referrals alleviates pressures on the outpatient department

INTRODUCTION

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.

METHODS

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.

RESULTS

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%.

DISCUSSION AND CONCLUSION

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.

Epidemiological Profile of ENT Emergencies: Our Experience

Emergencies in otorhinolaryngology are common occurrence. Early diagnosis and management result in reduction in morbidity and mortality. To assess the epidemiology, pattern and distribution of ENT emergencies at a tertiary level hospital. Cross sectional, retrospective, descriptive study over a period of 5 years. Medical records of these patients were studied, noting the age, sex, diagnosis on admission and outcome of emergency care. A total of 38,793 patients, age ranging from 15 days to 85 years were included in the study. The number of male and female patients were 25,971 (66.95%) and 12,822 (33.05%) respectively and the male to female ratio 2:1. The most commonly encountered emergency was epistaxis, which accounted for 25.58% of the emergencies attended. This was followed by ear ache and ear discharge. The ENT emergency ward plays a key role in the management of life-threatening conditions requiring immediate evaluation and management by specialized physician. It is important to prioritize and reduce the number of non-urgency/emergency cases attending the emergencies in order to ensure proper care is given to the emergency cases.

Prospective audit of a dedicated ear, nose and throat emergency department and 24-year comparison

BACKGROUND

The Royal Victoria Eye and Ear Hospital provides a specialised ear, nose and throat (ENT) Emergency department (ED) service open to patients from the entire country, operating from 9 am to 5 pm on weekdays. Recently, this has been under threat of closure.

AIMS

We analyse and determine the role of this ED in the current context and compare results to a previous study from June 1990.

METHODS

A prospective study over a 1-month period (March 2014) was conducted. A questionnaire was used, adapted from the study in 1990.

RESULTS

Comparative figures from June 1990 are in parentheses. During the study period, there were 945 (1167) consultations from 887 (779) patients. 57 % (45 %) were new patients and 43 % (55 %) were return patients. Repeat attendances were necessary in 54 (325) patients during this month. 56 % (35 %) were referred by their General Practitioner (GP), 38 % (52 %) self-referred, 2 % (8 %) by other hospitals and 4 % (5 %) from other sources. Diagnoses included otitis externa in 24 % (21 %), cerumen in 20 % (15 %), epistaxis in 6 % (9 %), Eustachian tube dysfunction in 12 %, foreign body removal in 4 % (5 %) and four new cases of head and neck cancer. Attendance numbers vary during the year but demand has risen over time.

CONCLUSIONS

A dedicated ED provides an important role for ENT in Ireland and offers valuable experience for trainees. The loss of such a department may lead to an overwhelming burden on services in other hospitals.

The ENT emergency clinic: does senior input matter?

BACKGROUND

Many ENT conditions can be treated in the emergency clinic on an ambulatory basis. Our clinic traditionally had been run by foundation year two and specialty trainee doctors (period one). However, with perceived increasing inexperience, a dedicated registrar was assigned to support the clinic (period two). This study compared admission and discharge rates for periods one and two to assess if greater registrar input affected discharge rate; an increase in discharge rate was used as a surrogate marker of efficiency.

METHOD

Data was collected prospectively for patients seen in the ENT emergency clinic between 1 August 2009 and 31 July 2011. Time period one included data from patients seen between 1 August 2009 and 31 July 2010, and time period two included data collected between 1 August 2010 and 31 July 2011.

RESULTS

The introduction of greater registrar support increased the number of patients that were discharged, and led to a reduction in the number of children requiring the operating theatre.

CONCLUSION

The findings, which were determined using clinic outcomes as markers of the quality of care, highlighted the benefits of increasing senior input within the ENT emergency clinic.

The ENT emergency clinic: a prospective audit to improve effectiveness of an established service

BACKGROUND

Ear, nose and throat emergency clinic services vary greatly between trusts. Their common aim is to enable acute conditions to be seen quickly and effectively within an optimum environment. There is however no 'gold standard' for service.

OBJECTIVES

To identify an efficient model of service, and to determine whether introduction of a referral and appointment based system improves patient waiting times and appropriateness of referrals.

METHODS

A prospective audit, comprising: an initial survey to appraise the existing service; telephone surveys of eight trusts in the West Midlands to determine variability of ENT emergency clinic services and to identify components of an effective service; and re-audit following implementation of a verbal referral and appointment based service.

RESULTS

The new service significantly reduced patient waiting times, from 70 minutes to 35 minutes (t = 6.776; p < 0.01), with an associated reduction in the variability of waiting times. Inappropriate referrals were reduced from 7 to 2 per cent. These results were achieved when a 72 per cent referrer compliance with the service was observed.

CONCLUSIONS

A verbal referral and appointment based system improves patient waiting times and appropriateness of referrals. Maintenance of high referrer compliance with such a system should be considered, and a tool for monitoring referring practitioners is suggested. This clinic construct model is offered as an example in order to aid delivery of an effective ENT emergency service in departments with similar patient demand and staff resources.