title: A baseline audit of referral and treatment delivered to patients in the intermediate minor oral surgery service in Croydon PCT.
abstract: BACKGROUND
  Patients attending for primary dental care may require oral surgery procedures beyond the capability of a generalist and thus need to be treated by a dentist with greater expertise. In the United Kingdom, it is increasingly accepted that such care may be provided in primary care settings by specialists or dentists with a special interest. In response to local pressures, an intermediate minor oral surgery (IMOS) service has been established in Croydon, south west London, to provide oral surgery treatment for non-urgent patients on referral.
  
  
  OBJECTIVE
  To audit the appropriateness and quality of oral surgery referrals after triage to an IMOS service in Croydon and to set standards for future audits on this topic.
  
  
  METHODS
  An audit tool was developed in line with the local referral guidelines and agreed with local stakeholders. Information on 501 (10%) triaged referrals to IMOS practices over a 24-month period was obtained through the referral management centre. A 10% sample of referrals per month to each practice was calculated and IMOS providers randomly selected the relevant patient records. Using an agreed audit pro forma, information on the indications for referral, treatment provided, and dates relating to patient management, in addition to the age and sex of patients, was collected from the IMOS providers by one investigator. Descriptive analysis of the data was performed.
  
  
  RESULTS
  Of the 501 patient records that were examined, 99% of patients were treated in IMOS practices, with only three (less than 1%) patients being referred on to hospital consultant services. The largest proportion (237; 40%) of referrals was for the extraction of teeth considered to have special difficulty, followed by lower third molars (154; 26%). Almost one-third (159; 32%) of patients were referred for more than one procedure. One in eight (72; 13%) teeth removed by the IMOS providers were recorded as a simple extraction without medical complications.
  
  
  CONCLUSIONS
  In general, patients were referred appropriately to the primary care oral surgery service in Croydon, with only a minority recorded as receiving simple care that should not have required referral. The clinician-led triage process using a referral management system worked well in selecting appropriate patients for treatment by IMOS providers in primary care and reduced referrals to hospital. Suggested standards for future audits of IMOS referrals have been set.
authors.affiliation: NHS South West London Croydon Borough Team, Public Health Directorate, Croydon, UK. eunan.o'neill@nhs.net
authors.forename: Eunan
authors.initials: E
authors.lastname: O'Neill
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Gallagher
authors.forename: Nick
authors.initials: N
authors.lastname: Kendall
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D019230:Dental Audit; D003752:Dental Health Services / Q000592:standards / Q000706:statistics & numerical data; D003796:Dental Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D013511:Minor Surgical Procedures / Q000592:standards / Q000706:statistics & numerical data; D008964:Molar, Third / Q000601:surgery; D019647:Oral Surgical Procedures / Q000592:standards* / Q000706:statistics & numerical data; D018579:Patient Selection; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data; D012737:Sex Factors; D013997:Time Factors; D014081:Tooth Extraction / Q000706:statistics & numerical data; D014850:Waiting Lists; D055815:Young Adult