title: Compliance of referral and hospital documentation with National Institute of Health and Care Excellence guidelines for the extraction of third molars: a comparative analysis of two NHS Trusts.
abstract: To find out whether documentation for the extraction of wisdom teeth complies with National Institute of Health and Care Excellence (NICE) guidelines, we reviewed the referral letters and hospital notes of patients treated at the maxillofacial unit of two NHS Trusts (A: 314 records and B: 280) over 12 months (1 September 2012 to 31 August 2013). Compliance was assessed as unsatisfactory ("indication for extraction not mentioned", "incorrect indication", "indication unclear") or satisfactory ("correct indication implied", "correct indication explicit"). The grade of the clinician who examined the patient was also recorded. A total of 194/314 (62%) referral letters in Trust A and 126/280 (45%) in Trust B were unsatisfactory (p<0.001). Hospital notes were unsatisfactory in 168/323 (52%) and 87/297 (29%) of cases, respectively (p<0.001). In Trust A, middle grades saw 23% (75/323) of the patients, as compared with 53% (157/297) in Trust B. In both, junior staff produced the highest percentage of satisfactory documentation, but in Trust A they were also responsible for most of the unsatisfactory examples. However, senior house officers saw 60% (195/323) of the patients in Trust A, and only 28% (83/297) in Trust B. Consultants were responsible for significantly more unsatisfactory documentation (p<0.001). One referral letter (0.2%) and seven hospital records (1%) explicitly and accurately complied with the guidelines. We conclude that compliance of documentation with the current NICE guidelines is poor and inconsistent.
authors.affiliation: Department of Oral & Maxillofacial Surgery, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE; Health Education England, Kent, Surrey, Sussex Deanery, and University of Kent, Centre for Professional Practice, Compass Centre South, Chatham Maritime, Kent ME4 4YG.
authors.forename: D G
authors.initials: DG
authors.lastname: Gray
authors.affiliation: Maxillofacial Unit, Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ; Health Education England, Kent, Surrey, Sussex Deanery, and University of Kent, Centre for Professional Practice, Compass Centre South, Chatham Maritime, Kent ME4 4YG.
authors.forename: J L
authors.initials: JL
authors.lastname: Franklin
authors.affiliation: Health Education England, Kent, Surrey, Sussex Deanery, and University of Kent, Centre for Professional Practice, Compass Centre South, Chatham Maritime, Kent ME4 4YG.
authors.forename: M K
authors.initials: MK
authors.lastname: Nicholls
authors.affiliation: Health Education England, Kent, Surrey, Sussex Deanery, and University of Kent, Centre for Professional Practice, Compass Centre South, Chatham Maritime, Kent ME4 4YG.
authors.forename: K A
authors.initials: KA
authors.lastname: Eaton
authors.affiliation: Department of Histopathology, Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ. Electronic address: Bill.Barrett@qvh.nhs.uk.
authors.forename: A W
authors.initials: AW
authors.lastname: Barrett
mesh_terms: D004282:Documentation / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D008964:Molar, Third / Q000601:surgery; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000592:standards*; D013222:State Medicine; D014081:Tooth Extraction; D006113:United Kingdom
keywords: NICE guidelines; third molar