Modelling clinical decision-making in triage of referrals for extraction

Oral surgery services are progressively moving out of traditional hospital departments and into primary care. This necessitates accurate methods of triaging referrals, so patients of varying complexity are managed in the most suitable environment. The latest NHS commissioning proposal identifies 'level 1' procedures as simple extractions which do not require referral. We developed a model for quantifying how accurately these simple extractions can be predicted from information in standard referral letters.

Experienced clinicians (N = 10) were independently asked to predict whether extractions (N = 25) were likely to be simple-forceps or surgical procedures, from information provided in specially developed standardised referral letters. One oral surgeon had previously completed all extractions. The triaging clinicians were asked to comment on reasons for each decision and state their level of confidence in their predictions.

Only 67% (range 52–76%) of extractions were correctly predicted as either simple or surgical with a significant propensity to underestimate the complexity of surgical extractions rather than overestimating simple procedures (p <0.05). High levels of confidence reported by the clinicians in their decisions correlated with more accurate predictions (p <0.05).

This is the first attempt to develop a model for clinical decision-making in oral surgery triage services. Our findings suggest there is significant scope for improvement and highlight areas for development.