MANAGEMENT GUIDELINES FOR IMPROVEMENT OF OTOLARYNGOLOGY REFERRALS FROM PRIMARY-CARE PHYSICIANS

OBJECTIVE AND DESIGN: A prospective evaluation of the effectiveness of otolaryngology evaluation, treatment, and referral guidelines developed collaboratively by otolaryngologists and primary care physicians on referrals and access to otolaryngology. Comparisons of appropriate to unnecessary referrals, the percentage of patients referred with disorders addressed to those without disorders addressed in the guidelines, access to otolaryngology, and questionnaire evaluations of primary care physician and patient satisfaction were measured before and after guideline implementation. RESULTS: A significant decrease in appropriate to unnecessary referrals was seen, from 55% before to 12% after guidelines. The percentage of patients seen within 1 month of scheduling improved from 39% to 59%. Guideline-addressed disorders decreased from 63% to 40%, The need for patients to see another physician for the referred symptom while waiting to see an otolaryngologist decreased from 31% to 3%. Patient satisfaction with wait times improved, Eighty-six percent of the primary care physicians used the guidelines, and 85% wanted to expand the guidelines to other specialty areas. CONCLUSIONS: Management and referral guidelines are effective in improving patient access and the ratio of appropriate to unnecessary referrals. Such guidelines are well accepted and used by primary care practitioners in this setting.