Audit of Referrals for Head

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Audit of Referrals for Head Neck Cancer
Patients for Pre-Radiotherapy Dental Assessment

• Emma Rattigan
• Dr Denise MacCarthy

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Introduction

• Head and neck cancer encompasses any cancer of
  the mouth, pharynx, larynx, salivary glands,
  bones and nerves of the face and neck

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Introduction

• Treated by surgery, chemotherapy and
  radiotherapy - lead to changes in the vascularity
  and cellularity of soft tissues and bone and
  damage to salivary glands

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Introduction

• Complications of Radiotherapy
• Increased risk of infection with clinical
  symptoms of dry and sore mouth.
• Pre-existing conditions can precipitate
  complications mucositis and osteoradionecrosis

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Introduction
Introduction

• Dental Assessment to reduce long-term oral
  problems and help facilitate radiation treatment

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Introduction

• Pre-radiotherapy assessments must be arranged
  urgently due to the nature of the disease
• Referrals from Consultants and members of their
  team
• Referral letters transfer information between
  these professionals and the dental team

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Aims Objectives

• Assess the quality and content of referrals to
  the dental team
• Use the information gathered to compile a
  standard letter of referral

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Method

• Referral letters for 77 patients referred into
  the hospital in 2006 for pre-radiotherapy dental
  assessment were analysed
• These were compared against a standard ideal
  referral letter
• Consideration given to guidelines in place

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Method

• Details sought
• Personal details of patient
• Clinical diagnosis
• Past medical history
• Treatment proposed
• Dental status of patient

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Results

• Wide spectrum of information received but with
  little consistency of content
• Information varied depending on the source
  nursing staff/junior doctors/consultants

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Results
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Results - Patient Details
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Results - Clinical Details
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Results - Social History
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Results - Treatment Details
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Outcome

• A standard format letter of referral for
  pre-radiotherapy dental assessment was designed
• Having a standard letter of referral letter
  would be beneficial in helping to streamline the
  care of these patients and reduce treatment times
• Improve treatment planning by knowing the dose
  and field of radiation to make an overall risk
  assessment of the proposed treatment on the oral
  health of the patient

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Conclusions

• A standard letter of referral is being piloted
  in St Lukes Hospital for the DDSH currently
  being audited
• Referrals by phone should always be followed by
  an accompanying letter
• Information should be succinct and easily
  readable as time is limited on clinics of
  referring doctor to ensure appropriate and
  relevant material is sent

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Acknowledgements

• I would like to thank Prof June Nunn, Dr Sinead
  Brennan and the records staff in the Dublin
  Dental Hospital for their help with this audit

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• Thank you