An Audit of Referrals to the Minor Operating Theater of the Patient Presenting in Otolaryngology OPD with Ear Discharge
Abstract
Introduction:  Despite a larger frequency of OPD patients requiring treatment, why is it not done in OPD should be addressed. Because there is no suction equipment in the ENT OPD, these patients who require suctioning are referred to ENT Emergency Room. This is a source of undue inconvenience for patients. This not only poses a risk to patient safety, but it also has major financial consequences, as well as a negative impact on patient satisfaction, which is a key indicator of treatment quality
Methods:  This is a closed-loop audit cycle beginning with the recognition of the problem and assessing the magnitude of the problem. Based on the burden of referrals to the MOT, the auditors proposed the changes in practice under hospital OPD guidelines enacted by Pakistan Otolaryngology Association.
Results:  A significant percentage of 52.5 is requiring ear suction in the first audit cycle. The percentage of patients that had to be referred to ENT OT decreased from 52.5% in the previous audit to a significantly low value of 9.5% in this audit. The role of this clinic is in decreasing the burden of referrals, reducing patients’ misery of going to the ER for suctioning, and improving patient satisfaction.
Conclusion:  Our study discerns the fact that the implementation of some simple protocols will lead to immense change. The resultant reduction in clinical activity will lead to a reduction in the workload of the doctors too.
Keywords: Audit, ear discharge, otolaryngology, minor operation theatre, suctioning
Key points :
  1. Ear suctioning should ideally be performed in the OPD to remove ear discharge, wax, or fungal debris, clean the ear canal, view the middle ear cleft, and allow antibiotic drops to reach the infected area and act more effectively.
  2. More than half of the patients in the 1st audit cycle require suctioning. So, it was recommended that since a significant percentage of 52.5 is requiring ear suction, it should be started in the OPD department so that the unnecessary referral to the ENT MOT would be reduced.
  3. When ear suctioning was incorporated as an OPD procedure, the percentage of patients that had to be referred to ENT OT decreased from 54.5% in the 1st audit to a significantly low value of 9.5% in the 2nd audit.
  4. Our study has stated a 2-fold advantage. Firstly, that will be an overall tremendous decrease in the number of patients that will still need to be referred to a clinic or OT (primary outcome). Secondly, financial sustainability and less need for time and transportation will bring a greater chance for a poor population like us.
  5. We recommend that the suctioning apparatus should be routine equipment in the out-patient clinics and the health professionals working in OPD must be trained to mop with suctioning when indicated.