ENT  |  Elective Services




ENT

Elective Services

ENT referrals are prioritised by senior medical officers based on the information contained within. Additional information  should be attached where available. The priorisation tool used to grade referrals can be found under Access Criteria.

All ENT conditions that are secondary to trauma in NZ are covered by ACC but an ACC claim number and date of injury must be included in the referral.  The claim must be registered with and accepted by ACC prior to the consultation.

All accepted referrals will be seen within a maximum waiting time of 4 months, unless there is a clinical reason for delay.

Referral acceptance is a follows:

First Specialist Assessments

 

Waiting priority 1

Accepted

Waiting priority 2

Accepted

Waiting priority 2A

Accepted

Waiting priority 2B

Accepted

Waiting priority 2C (child hearing loss)

Accepted

Waiting priority 3

Declined

Waiting priority 4

Declined


At First Specialist Assessment (FSA), patients are assessed by a specialist and if surgery is required, patients are then prioritised using the National ENT CPAC tool.  A 0-100 score is allocated to each patient.

Prior to acceptance for surgery, patients are assessed in Anaesthetic preassessment clinic to ensure they are fit for surgery.

All patients accepted for surgery will be treated within a maximum waiting time of 4 months, unless there is a clinical reason for delay.

Surgery acceptance is as follows:

Treatment List

CPAC score 30 and above

Accepted 

CPAC score 29 and below / Non urgent

Declined

 

Access Criteria:

National Access Criteria for First Assessment (ACA)

Bay of Plenty Variation (Aug 16)

Note: Access criteria that determine prioritisation primarily on the referral diagnosis have their limitations and this is acknowledged.  For those referrals in which the referring doctor has not been able to make a confident diagnosis it may be difficult, or impossible, to apply these ACA criteria.  It is therefore stressed that these are guidelines only and that clinical judgement must be applied in all cases in which they are used.

REFERRAL GUIDELINES:  ORL / ENT 

Category

Criteria

1. Urgent
(within 2 weeks)

    • Failure of immediate treatment would result in significant morbidity
    • Suspected malignancy
    • Major functional impairment
    • Uncontrolled pain and/or infection
    • Trauma not requiring immediate attention
    • Moderate risk of permanent damage to tissues or systems

2. Semi-Urgent
(within 4 – 6 weeks)

    • Moderate functional impairment
    • Marked restriction of social or economic activity
    • Conditions causing frequent recurrent infective episodes
    • Poorly controlled pain

2a. Non Urgent
(within 4 months)

    • OSA - separated out for ease of identification

2b. Non Urgent
(within 4 months)

    • Asymmetrical Hearing Loss - separated out for ease of identification

2c. Non Urgent
(within 4 months) 

    • Child Hearing Loss - All referrals regarding hearing loss in children -separated out for ease of identification.

3. Non- urgent
(within 4 months)

  • Mild-moderate degrees of the above and/or unlikely to require surgical intervention
      • Does not appear to meet Primary Referral Management Guidelines (tonsillitis/sinusitis) for secondary referral.
        Conditions where there is a slight risk of permanent damage if treatment is delayed.

4. Routine
(within 4 months)

    • Minimal functional impairment
    • Social impairment but minimal restriction of social and/or economic activity
    • Cosmetic or acquired aesthetic disability of a minimal nature


Notes:

Specific Referral Information:

  • ACC fractures - refer to Private Practitioner wherever possible
  • Industrial hearing loss - ACC form and referral to Private Practitioner.
  • OSA - direct to ORL only where there are upper airways signs or symptoms.
  • Vertigo- direct to ORL in presence of otorrhoea, unilateral tinnitus, unilateral  hearing loss

Tests Required:

  • Tympanometry in OME - send result or comment on.
  • Audiology for other than child hearing loss.
  • Chest x-ray for cough.
  • Barium swallow for dysphagia, consider for cough.
  • Skin biopsy where indicated.
  • NB Sinus x-rays are a poor screening tool.

Other Information:

Please include all relevant:

  • Radiology, audiology, pathology and laboratory investigations.
  • Private or out of district assessments
  • Public/community health nurse assessments.
  • Past and current medical history

Smoking status is mandatory on adult ORL referrals.



Last updated : Friday, August 12, 2016
Next review date : Saturday, August 12,2017


Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.