Patient-specific variables predicting triage outcomes of ear, nose, throat referrals from primary care for dysphonia.

Abstract

Background: Patients with dysphonia are referred to Speech-Language Pathologists (SLP) or Ear Nose and Throat (ENT) surgeons from General Practitioners (GPs) for specialist assessment. Accurate referral information is needed to determine the assessment-pathway and priority. This study aimed to examine which patient-specific information provided in GP referral documents predicted clinicians' triage outcomes.

Methods: This was an IRB-approved retrospective study of electronic medical records of 150 voice-disordered adults aged ≥ 18 years referred to a tertiary hospital specialist ENT department between March 1, 2019, and July 1, 2020. Data collected included demographics, voice symptoms, risk factors, and medical history. ENT clinicians triaged all patients to either SLP or ENT assessment-pathway and recommended a priority categorisation. The predictive values of documented information in the referral on assessment triage outcome were analysed using logistic regression.

Results: Eighty referrals reported hoarseness as the only symptom, only eight reported three or more symptoms. Female gender, previous smoking history, and current smoking history significantly predicted the ENT-pathway for initial assessment. The same variables plus previous thyroid surgery significantly predicted triage to high-priority assessment. However, a quarter of referral letters did not include information about smoking and alcohol consumption.

Conclusion: Gender and smoking history were significant predictors of triage outcomes. No significant association was found between referral symptoms and the triage outcomes. The exclusion of relevant lifestyle and health information likely impacted decision-making at triage. More detailed information specific to voice disorder risk factors included in GP written referrals may provide critical missing details required to prioritise referrals accurately.