Improvement of the ENT emergency clinic service

Henry Dunne

Abstract

Improvement of the ENT emergency clinic service

Introduction: The Covid-19 pandemic and the associated need for admission avoidance highlight the importance of an effective ENT emergency (EMENT) service1,2. This quality improvement project provided a holistic review of Addenbrooke’s EMENT clinic and had the following aims:
To reduce inappropriate referrals.
To streamline referral pathways.
To increase capacity for new referrals.
To improve the 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-up, and 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 the 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.