Published online Jun 16, 2015. doi: 10.12998/wjcc.v3.i6.495
Peer-review started: January 7, 2015
First decision: February 7, 2015
Revised: March 9, 2015
Accepted: April 8, 2015
Article in press: April 9, 2015
Published online: June 16, 2015
A closed loop audit of the ear nose and throat (ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed, referral source, appropriateness of referral, presenting complaint and assigned follow-up appointments. Data was sourced from clinic letters and the patient appointment system over a 3-mo period. The initial cycle analysed 490 patients and the subsequent cycle 396. The initial audit yielded clinically relevant and cost effective recommendations which were implemented, and the audit cycle was subsequently repeated. The re-audit demonstrated decreased clinic numbers from an average 9.8 to 7.2 patients per clinic, in keeping with ENT United Kingdom guidelines. A 21% decrease in patient follow-up and 13% decrease in inappropriate referrals was achieved. Direct bookings into outpatient clinics decreased by 8%, due to correct referral pathway utilisation. Comparisons of all data sets were found to show statistical significance P < 0.05. We reported a total financial saving of £32490 in a period of 3 mo (£590 per clinic). We demonstrated that simple guidelines, supervision and consultant-led education which are non-labour intensive can have a significant impact on service provision and cost.
Core tip: The implementation of simple clinical guidelines, a transparent referral pathway to the ear nose and throat urgent referral clinic, and consultant led education to both juniors and referring specialties has demonstrated an improved service provision whilst being more cost effective and efficient.