Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2015; 3(6): 495-498
Published online Jun 16, 2015. doi: 10.12998/wjcc.v3.i6.495
Improving efficiency and saving money in an otolaryngology urgent referral clinic
Nader Ibrahim, Jagdeep Virk, Jason George, Behrad Elmiyeh, Arvind Singh
Nader Ibrahim, Jagdeep Virk, Jason George, Department of Otolaryngology, Queen’s Hospital, Essex RM7 0AG, United Kingdom
Behrad Elmiyeh, Arvind Singh, Department of Otolaryngology, Northwick Park Hospital, Middlesex HA1 3UJ, United Kingdom
Author contributions: Ibrahim N and Virk J contributed to the data interpretation, analysis and construction of paper; George J contributed to the data collation and analysis and interpretation; Elmiyeh B and Singh A contributed to the concept design and senior authorship.
Conflict-of-interest: The author reports no conflicts of interest in this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Nader Ibrahim, MBBS, Bsc, Department of Otolaryngology, Queen’s Hospital, Rom Valley Way Romford, Essex RM7 0AG, United Kingdom.
Telephone: +44-1708-435000 Fax: +44-1162-585852
Received: January 5, 2015
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.

Keywords: Otorhinolaryngologic diseases, Quality of health care, Clinical audit, Practice guideline, Total quality management, Ambulatory care facilities

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.