Bay Navigator

Ear Nose and Throat

Referral Acceptance

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 3

Limited Number Accepted per month

Waiting priority 4

Declined

Waiting priority 5

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 (Jan 2020)

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 14 days)

  • Failure of immediate treatment would result in significant morbidity
  • High suspicion of 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 - 8 weeks)

 

  • Moderate suspicion of malignancy
  • Moderate functional impairment
  • Moderate uncontrolled pain and/or infection
  • Trauma not requiring immediate attention
  • Moderate risk of permanent damage to tissues or systems

3. Non-urgent
(within 4 months)

  • OSA
  • Asymmetrical Hearing Loss
  • Child Hearing Loss - All referrals regarding hearing loss in children 

4. Routine
(within 4 months)

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

5. Routine
(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.
  • 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
  • Referral for tonsillitis and rhinosinusitis should be made in accordance with BOP DHB Primary
  • Referral management guidelines for these conditions.

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.