Transcript (blank) Audiology Consultant Slide 1 Slide 1 Slide 1 Slide 1 Slide 1

ENT Referrals – IQSP Day 20th May 2014
Why ENT…
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Referral rates high
Mostly first appointments
WRH keen to reduce and help out
Embrace the offer and keenness from the
WRH!!
What….
• Initial discussions with Steve Lewis – keen to
help out
• Audit of referral letters:
• Definitely WRH
• Primary care treatment
• Middle ground - GPwSI
Audit results
Referral Source
Age
Partner
0-5
Associate
6-19
Locum
20-64
Registrar
65-74
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75+
Audiology
Consultant
Referral type
600
500
400
300
200
487
100
59
0
Routine
2 week wait
7
(blank)
6
Private
3
Urgent
Reasons for referral
(top 16)
3%3%
3%
3%
5%
5%
5%
3%
16%
11%
9%
6%
6%
7%
8%
8%
Neck lumps/goitre
Tonsillitis
Dizziness/vertigo
Other
Dysphonea
Conductive deafness
Sensireneural deafness
Tinnitus
Snoring
Epistaxsis
Sore throat
Sinusitis
Glue ear
Nasal obstruction
Rhinitis
Malignancy
Conditions that need to be dealt with
in secondary care….
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Neck lumps
Malignancy
Microsuction
Tongue tie
Acute admission – uncontrolled epistaxis,
tonsillitis, quinsy
Snoring
• No longer an ENT problem
5%
5%
9%
29%
Onward referral
Advice
Further testing
Surgery
19%
14%
19%
Monitor
No treatment
Active treatment
Rhinitis
9%
9%
Active treatment
Further tesitng
Reassuance
18%
64%
Surgery
Tinnitus
11%
6%
28%
Further testing
Advice
6%
Surgery
Referral
Hearing aid
Treatment
22%
22%
5%
No treatment
Reflux
5% 5%
11%
Referred on
Active treatment
Reassured
No treatment
79%
Epistaxis
6%
19%
Cautery
Antibiotics
No treatment
14%
61%
Other treatment
Dizziness
6%
18%
27%
Hearing aid
No treatment
Investigation
Treatment
Referral
31%
18%
Conductive Hearing Loss
11%
7%
Hearing Aid
45%
11%
Investigation
Surgery
Other treatment
No information
26%
Primary care conditions
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Snoring
Rhinitis
Chronic sinusitis
Deafness
Reflux
Some thoughts
• Good primary care
• Appropriate referrals (80% sinus referrals had
surgery or Ix – CT)
• Glue ear well managed in primary care
• Guidelines – tonsillectomy done
• Small numbers
• could more be done in primary care?
Possible primary care conditions
• Tinnitus
• Dizziness
• Could this be delivered by pathway design?
Reflection
• My initial thoughts …..
– Very good primary care
– Appropriate referrals
– However more could be done in primary care
– Opportunity to develop the service
Thinking time
• What could be done in primary care now
• What could be done with more specialist
knowledge
• Which areas for pathway redesign
• Which areas would you want more guidelines
on