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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.
Introduction:
The ENT emergency clinics often rely on SHO (Senior House Officer) level clinicians, such as Foundation Doctors and Core Trainees, to triage and assess urgent referrals. Emergency clinics receive urgent referrals for both adult and paediatric patients. Inconsistent adherence to locally available referral guidelines, which indicate what is appropriate for emergency clinic booking and what is not, can lead to inappropriate clinic utilisation, resulting in inefficiency and suboptimal patient care. This study aimed to evaluate guideline adherence in paediatric-only referrals to an SHO-led ENT emergency clinic in a tertiary centre and determine whether simple, low-cost interventions could improve and sustain compliance.
Methods:
This study was a six-cycle Quality Improvement (QI) project. All paediatric patients seen in an SHO-led ENT emergency clinic between December 2020 and November 2022 at Queen's Medical Centre, Nottingham, UK, were analysed. A total of 209 encounters were reviewed using the Trust's electronic record system. Referral reasons were compared with the local Trust paediatric ENT emergency clinic referral guidelines. The PDSA (Plan Do Study Act) framework for QI was applied, and following the baseline audit, interventions included targeted junior doctor teaching, dissemination of referral criteria via online communication platforms, and a poster campaign in key clinical areas.
Results:
Baseline adherence was 38.5% compared with a benchmark standard of 100% adherence. Following educational and communication-based interventions, the proportion of guideline-compliant referrals increased to 74.0%. This improvement achieved statistical significance and was sustained across subsequent audit cycles despite frequent SHO turnover. Staff demonstrated the strongest adherence in referrals for foreign bodies and epistaxis. Common inappropriate referrals included cerumen impaction and a discharging ear.
Conclusions:
Simple and sustainable interventions, including structured teaching, digital dissemination, and poster-based prompts, significantly improved guideline adherence in an SHO-led paediatric ENT emergency clinic. This low-cost QI model is easily reproducible in similar healthcare settings.
