Improving the GP Referral Process to an ENT Outpatient Clinic

In the Health Service Executive the general practitioner (GP) acts as an arbitrator to secondary specialist care. The patient referral is a key aspect of the GP role. The referral involves a transfer of clinical responsibility between professionals; however, the current Irish process is variable and unsustainable. There is an inconsistency of information in referrals directed to the Otolaryngology (ENT) department of a teaching hospital in Dublin. This Quality Improvement (QI) project plan centres on improving the GP referral process to an ENT outpatient clinic. The intent is to provide GPs with an explicit referral pathway for the most commonly referred presenting complaints. Consequently, creating a standardised referral process, and, over time, decrease the long outpatient waitlist. Adopting specific QI tools, including a driver diagram and process flow map, the factors contributing to unnecessary referrals were identified. The data collected identified the five most commonly referred ENT conditions: Sinusitis (21.8%), Tonsillitis (21.1%), Hearing Loss (20.7%), Tinnitus (20.1%) and Swallow Disturbance (16.1%). A sample of 51 referrals were benchmarked against the national standard referral form and graded to a maximum of 39 points. The results exhibited that 47% were eReferral and 53% were paper, achieving average scores of 23.8 and 19, consecutively. In total 92% of referrals were deemed ‘inappropriate’. A concise GP guideline titled ‘The Top Five’ was created for implementation and consists of clear, supportable ENT referral guidance. The intent is to provide a structured GP ENT referral and management pathway for patients depending on their clinical need.