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Sustained Improvement in Paediatric ENT Emergency Referral Accuracy Through a Multimodal Educational Strategy: A
Raul Simon1,2, Matija Daniel1
1ENT Department, Nottingham University Hospitals NHS Trust, Nottingham, GBR.
Cureus
|December 31, 2025
Summary
Improving adherence to ENT referral guidelines in paediatric emergency clinics is crucial. Simple interventions like teaching and digital communication significantly boosted compliance, enhancing patient care and clinic efficiency.
Area of Science:
- Otolaryngology
- Quality Improvement Science
- Pediatric Emergency Medicine
Background:
- Senior House Officer (SHO) clinicians manage urgent ENT referrals in emergency clinics, impacting patient care.
- Inconsistent adherence to referral guidelines leads to inefficient clinic utilization and suboptimal patient outcomes.
- This study focuses on improving guideline adherence for pediatric ENT referrals in a tertiary center.
Purpose of the Study:
- To evaluate adherence to pediatric ENT referral guidelines in an SHO-led emergency clinic.
- To assess the impact of simple, low-cost interventions on guideline compliance.
- To determine if improved adherence can be sustained over time.
Main Methods:
- A six-cycle Quality Improvement (QI) project analyzed 209 pediatric ENT encounters from December 2020 to November 2022.
- Referral reasons were audited against local Trust guidelines using the electronic record system.
- Interventions included junior doctor teaching, online dissemination of criteria, and poster campaigns, guided by the PDSA framework.
Main Results:
- Baseline adherence to referral guidelines was 38.5%, far below the 100% benchmark.
- Post-intervention, guideline-compliant referrals increased significantly to 74.0%.
- Adherence improved for foreign body and epistaxis referrals; cerumen impaction and discharging ear were common inappropriate referrals.
Conclusions:
- Targeted teaching, digital communication, and visual prompts effectively improved guideline adherence in pediatric ENT emergency clinics.
- These low-cost, sustainable interventions are reproducible in similar healthcare settings.
- The QI model demonstrates significant improvements in clinic efficiency and patient care through better referral management.
