An Ear, Nose and Throat (ENT) emergency clinic provides important access to specialist care for patients referred by General Practitioners (GPs), Emergency Departments and doctors on non-ENT hospital wards. The aim is to enable the prompt diagnosis and management of acute conditions, within an optimum environment containing appropriate clinical and staff resources.Amid concerns that an open access ENT casualty service had become overburdened we performed a four week audit of all attendances. We identified 45% of patients presenting to the clinic without having evidence of first accessing primary care assessment or treatment. Waiting times were unpredictable, averaging 75 minutes and clinic numbers above those recommended to be safe in national guidelines. 60% of attendances to the department were judged to be inappropriate.Subsequently the ENT emergency service was changed to an appointment based Rapid Access Clinic, with an easily accessible and prompt triage facility provided by a trained triage nurse. Concurrently the opportunity was taken to improve record keeping and formalise post consultation communication.Re-audit confirmed a 43% reduction in the number of patients accessing the ENT emergency clinic facility, allowing individual clinic numbers to fall to safe levels. Average patient waiting times fell by 70% to 22 minutes. The number of referrals judged to be inappropriate was halved.The transformation of our service has enabled time and resources to be more effectively directed towards a smaller number of patients, whose needs are more urgent.

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Aim The Royal Victoria Hospital adopted ENT UK’s pandemic guidelines for the management of epistaxis. We aimed to reduce ENT referrals, in-patient admissions and staff exposure to COVID-19 whilst maintaining patient safety. This involved collaboration with ED to promote the use of absorbable packs and pharmacological alternatives over rhinoscopy & rigid endoscopy with cautery +/- non-absorbable packs. Method Data was collected on patients presenting with epistaxis over a six-week period beginning March 2020 and the same period in 2019. Key factors recorded were number of presentations, ENT referrals, admissions, and their durations, along with management and outcomes. ENT provided training to ED staff and produced video resources for the "My ED" app. Feedback from ED and patient data was gathered to improve training and assess effectiveness. Results Pre-pandemic, 48% of ED epistaxis presentations were referred to ENT vs. 28% following the guidelines introduction. In 2019 49% of referrals were admitted vs. 42% in 2020. The average in-patient stay was reduced from four nights to one. Re-admission rate remained similar from 22% in 2019 to 20% in 2020. These results were achieved following repeated improvements to the training sessions. Conclusions The ENT UK guidelines, when supplemented with ED collaboration, are effective at reducing ENT referrals and admissions. In addition to reducing COVID-19 exposure, the guidelines offered an improved patient experience (less invasive intervention, reduced/removed in-patient stay) with no loss of efficacy. This, combined with a reduced treatment cost of ∼£2,000 per in-patient, suggests the guidelines have long-term value out-with a pandemic setting.