Enhancing communication between primary care and specialised services: a quality improvement project to reduce inappropriate expedition requests

Waiting times for NHS ear, nose and throat (ENT) services have been a pressing issue for several years, exacerbated by the COVID-19 pandemic and a workforce crisis. In the authors' ENT department, an increased number of requests for new appointments and follow ups were observed, alongside requests for operation dates to be brought forward. The majority of these requests did not seem to result in appointments being expedited. Therefore, this quality improvement project aimed to enhance communication and guidance to GPs in order to reduce the number of expedition requests being sent to the department and thus the administrative burden for both the hospital and GP practices. All expedition requests sent from GPs to the department during a 3-month period in 2023 were analysed to determine whether the request should be fulfilled, in line with departmental practice. A guidance document was then produced and circulated to all referring GPs in the region. A re-audit of the expedition requests was then performed, finding a 21% reduction in the average number of letters received per day and a 100% reduction in the number of requests to expedite operation dates for patients already listed for procedures. The number of requests regarding patients with suspected cancer symptoms (who should be referred by the 2-week wait pathway) and the number of requests that led to an expedition also fell, but this change was not statistically significant. Meanwhile, the average time from referral date to GP expedition request fell from 200 days to 114 days. Overall, this project suggests that clear guidelines between primary and specialist care can help to reduce inappropriate expedition requests, which could help to reduce the administrative burden on both services.