Title: Improving emergency department referrals to oral and maxillofacial surgery: A quality improvement project
Abstract:
Background: Emergency Departments (ED) frequently refer patients with dental and facial conditions to Oral and Maxillofacial Surgery (OMFS) services. However, a proportion of these referrals are inappropriate for specialist review and could be more appropriately managed in primary care or community urgent dental services. Inappropriate referrals can contribute to delays in patient care, increased pressure on acute services, and inefficient use of specialist clinical resources. Improving referral pathways is therefore important to ensure patients receive timely care in the most appropriate setting.
Aim: This quality improvement (QI) project aimed to identify the frequency and nature of inappropriate ED referrals to the OMFS team and to develop strategies to improve referral pathways and ensure patients access the most appropriate service.
Methods: A prospective data collection process was implemented within the OMFS department at a large UK teaching hospital. Over several months, members of the OMFS team recorded inappropriate referrals received from ED. For each case, anonymised patient identifiers were logged alongside the presenting complaint, reason for referral, explanation of why the referral was deemed inappropriate, and the eventual patient outcome. Data were subsequently collated and analysed to identify common patterns and recurring causes of inappropriate referral. Following analysis, collaboration with ED clinicians was undertaken to develop a clearer referral protocol and improve awareness of appropriate OMFS referral criteria. Feedback was gathered from both ED and OMFS staff regarding the proposed pathway changes. Patient experiences were also explored to better understand the impact of referral pathways on patient journeys.
Results: Findings demonstrated a substantial number of inappropriate referrals, with recurring themes including dental pain without acute complications, conditions better managed in primary dental care, and uncertainty regarding referral pathways. Early feedback from ED and OMFS staff has been positive, with improved clarity regarding referral criteria and service availability.
Conclusion: This QI project highlights the importance of interdisciplinary collaboration in improving referral pathways between ED and specialist services. Implementing clear guidance and communication between departments can reduce inappropriate referrals, improve patient flow, and ensure patients receive timely care in the most appropriate setting. The findings are being used to inform local service improvements and support more effective signposting to community urgent dental care.
