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  • AUDIT CYCLE A closed loop audit was performed with implementation of new guidelines after the initial cycle, highlighting key areas of improvement. Local guidelines were constructed on the basis of our findings. Data for each audit cycle was sourced from clinic letters, each over a period of 3 mo, conducted at Northwick Park Hospital. The initial audit analysed 490 patients and the subsequent re-audit 396 patients. The primary outcome measure of this study was the number of patients reviewed in each urgent referral clinic and whether these were in line with the standards set by MK2206 ENT United Kingdom[5]. Data pertaining to the following was also evaluated: (1) the source of the original referral; (2) the presenting feature; (3) the number of follow up appointments for each patient; and (4) the appropriateness of the referrals and whether patients were diverted towards main outpatient clinics, ultimately causing a loss of funding. Data was analysed using GraphPad prism v5.0 (San Diego, California, United States) with a P value of < 0.05 considered statistically significant. SUMMARY OF DATA FROM INITIAL AUDIT CYCLE All TRIB1 patients reviewed in the urgent referral clinic in a 3-mo period were analysed both in the initial and subsequent re-audit. The initial audit analysed 490 patients during a 3-mo period from the urgent referral ENT clinic at Northwick Park Hospital. An average of 9.8 patients were reviewed in each clinic. selleck kinase inhibitor Thirty-two percent (158 patients) were listed for follow up appointments after assessment in the urgent referral clinic. Twelve percent (59 patients) were direct outpatient bookings rather than registration through the ��choose and book�� service and therefore bypassed the appropriate referral and funding pathway. Re-referrals via the GP only consisted of 0.2% (1 patient) which is a source of income generation for the trust. Eighteen percent (89 patients) of referrals were deemed to be inappropriate for urgent referral review by a designated senior clinician and were suitable for either GP review or non-urgent ENT review. The most common presentation to the ENT urgent referral clinic was otitis externa consisting of 26% of patient reviews. The others included 16% nasal trauma, 15% removal of a foreign object and 11% with epistaxis which are consistent with similar audits conducted[3]. Based on the above findings from the initial cycle, the following guidelines were implemented: (1) clinical protocols were produced for ENT juniors regarding accepting, reviewing and organising subsequent follow up for patients; (2) clinical guidelines for the management of common ENT pathologies, i.e.
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