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Oxford University Hospitals NHS Foundation Trust

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JR staff praised for managing ENT emergencies

06/11/2019
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national report by the Getting It Right First Time (GIRFT) programme has highlighted the work of staff at the John Radcliffe Hospital's GP Referral Unit (GPRU) in successfully managing ear, nose and throat (ENT) emergencies.

The GIRFT report, which recommends a range of measures to ensure the right patients are admitted to hospital, praised good practice at the John Radcliffe Hospital - part of Oxford University Hospitals (OUH) NHS Foundation Trust - where staff at the GPRU see more than 450 non-elective (urgent or emergency) adult patients every month.

As well as easing pressure on the Emergency Department, the GPRU has improved diagnostic certainty, meaning 75 percent of ENT patients admitted to the hospital go on to have a procedure, compared to a national average of 49 percent. In addition, the ability of staff in the GPRU to treat conditions such as tonsillitis and ear infections intravenously means ENT admissions have fallen, as patients do not need to be admitted to the hospital. The reduction in admissions means the inpatient ward can now treat 25 cataract patients every day.

The Trust is now looking to employ advanced nurse practitioners in the GPRU to provide even more care without the need to admit patients.

Professor Meghana Pandit, Chief Medical Officer at Oxford University Hospitals, said: "We are very pleased that OUH has been recognised as an example of best practice for managing ENT emergency cases and I want to thank our ENT staff for setting up such an innovative service.

"Through our GPRU more people with ENT problems can be seen in a short time allowing us to detect conditions at an early stage when it's still possible to treat them at home. This has reduced significantly the number of admissions which in turn means we are able to use inpatient beds and theatre capacity for other patients at no extra costs."

"This service also relieves the pressure on our Emergency Department."

The GIRFT report on ear, nose and throat (ENT) surgery is the ninth national report from the Getting It Right First Time programme and follows a review of 126 ENT departments across England. Written by Mr Andrew Marshall, a consultant ENT surgeon at Nottingham University Hospitals NHS Trust, it makes 23 recommendations designed to improve the experience for hundreds of thousands of patients every year by lowering the number of admissions and repeat visits and potentially reducing waiting times.

The review found that thousands more ENT patients could be treated on a day case basis rather than having an overnight stay in hospital. Suggested actions aimed at increasing day case rates include trusts having a dedicated day case unit or bed where possible, reviewing administrative processes to ensure patients can be listed as a day case, prioritising cases to morning or early afternoon theatre lists, and carrying out capacity planning.

As well as enabling patients to get home more quickly, increasing day case rates for tonsillectomy operations could release between £1.4m and £3.7m per year for the NHS.

Mr Marshall said: "There is a huge opportunity for more of the national ENT caseload to be treated on a day case basis if the right facilities and working practices can be put in place. Increasing the use of day case treatment in ENT would benefit patients as well as ENT units and their trusts, making units more resilient to pressures on beds and allowing hospitals to free up beds for other people.

"I have seen some remarkable work being done in ENT units across the country as I have carried out visits for this review. I hope the good practice case studies in the report and my recommendations help to bring about improvements which will make life better both for the NHS staff who work so hard and for the patients, who deserve the best possible care at all times."

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