Reducing inappropriate ENT referrals

Cox and colleagues1 highlight the problem of increasing numbers of outpatient referrals, many of which are thought to be inappropriate. Ear, nose, and throat (ENT) problems are common in primary care2 and appropriate referral is crucial. We investigated GP referrals to the one-stop emergency ENT clinic at St George’s Hospital, London. Criteria for referral to this clinic include: otitis externa (needing microsuction), recurrent epistaxis, fractured nose (needs to be seen within 7–10 days of injury), foreign bodies in the ear, sudden unilateral sensorineural hearing loss, and Bell’s palsy.

We collected prospective data on 100 consecutive primary care referrals in April–May 2013. The patients’ mean age was 41 years (range 1–88 years), 24 were children aged <12 years, and 47 were male. Referrals were triaged by an ENT senior registrar or consultant and 65 were accepted.

Of the remaining 35 referrals deemed inappropriate, seven were for microsuction of wax, six patients had neck lumps or hoarse voice (2-week referral), three had otitis media (referral to paediatric/general ENT clinic), two had possible cholesteatoma (referral to otology clinic), four had tinnitus or vertigo (referral to audiovestibular clinic), two had chronic sinusitis (referral to rhinology clinic), two had hearing aid problems (referral to audiology clinics), and nine had other conditions.

We believe that recognition of criteria for emergency ENT clinic referrals and an awareness of the many different subspecialist ENT clinics available may help GPs refer more appropriately and provide efficient care. Hospitals should keep GPs regularly updated in their acceptance criteria for the different clinics and publish this information on their websites. This is important in view of Cox and colleagues’1 findings that referral management schemes are expensive and do not seem to reduce outpatient attendance rates.

• © British Journal of General Practice 2013