A prospective audit of acute ENT activity in a university teaching hospital

Introduction and aim: Acute ENT coverage is available out-of-hours in most hospitals. However, increasing pressure to reduce healthcare cost threatens this 24-hour availability. Our goal was to audit the emergency ENT activity in our institution.
Methods: A prospective audit of all ENT emergency referrals was carried out over a one-month period in an academic hospital. Descriptive statistics were produced for age, sex, origin, admission time, diagnosis, management, and patient outcome.
Results: A total of 190 patients (109 men and 81 women) were referred to the ENT emergency service over the study period (mean, 6.1 cases/day). Mean age was 47.9 (SD ±23.6) years. Most admissions (76.4%) occurred during normal working hours, and 62.0% of patients were self-referred. The mean complaint duration before admission was 7.6 (±13.7) days. One third (33.2% patients) required ambulatory treatment, a quarter (24.7% patients) had a minor ENT procedure,
18 (9.5%) required admission to the ward, and 8 (4.2%) required surgical treatment. Severity of diagnosis or management between patients did not differ with referral by a physician (GP or specialist) and self-referral. At 30 days, 3 (1.6%) patients died, 106 (55.8%) benefitted from an ENT follow-up, 65 (34.2%) were referred to another physician (GP or specialist), and 16 (8.4%) were lost to follow-up.
Conclusions: The results of this workload audit suggest that emergency ENT activity is justified in our hospital. Restricting emergency ENT cover to patients referred by a GP or another physician would not improve patient selection.