Too Many Calls? Auditing Emergency Department Referrals to OMFS

Introduction:
Emergency Departments (ED) frequently refer patients to Oral and Maxillofacial Surgery (OMFS). Many referrals are inappropriate or do not require specialist input. Unnecessary referrals increase workload, delay care, and strain resources. Local data on referral appropriateness are limited, making targeted interventions difficult. Evaluating referral quality is essential to ensure timely specialist care and optimise service efficiency. The aim of this study was to assess appropriateness of ED referrals to OMFS and ED staff confidence in the referral pathway.

Methods:
A retrospective audit was carried out over 21 days of ED referrals to OMFS. Referrals were categorised as appropriate, inappropriate, or uncertain using pre-defined criteria. Secondary outcomes included admission rates, cases managed with advice alone, and presentations suitable for ED or primary care. A short survey of 10 ED clinicians assessed confidence and familiarity with the OMFS referral pathway.

Results:
During the study period, 117 referrals were received. While the majority were appropriate, 21% were not. The most frequent inappropriate referral was dental pain without acute infection, followed by minor soft tissue injuries and chronic conditions better managed in outpatient or community settings. Only a small percentage required admission, while many were discharged after simple interventions or managed via telephone advice. The survey revealed variable confidence in referral decision-making, with several clinicians reporting uncertainty about when OMFS input was needed. Other issues included incomplete documentation and inconsistent use of referral criteria.

Conclusions:
A considerable number of ED referrals to OMFS were avoidable. The survey suggests that knowledge gaps and lack of confidence contribute to inappropriate referrals. Education, clearer guidelines, and improved pathways may reduce unnecessary referrals and ensure timely specialist input for patients who need it most.