Assessment of referral complexity and case acceptance for NHS hospital orthodontic treatment

Abstract

Introduction NHS orthodontic service provision is restricted to those who present with the highest level of need. By auditing the complexity of referrals received and assessing those accepted by a hospital orthodontic department for treatment, we can quality assure the processes in place and demonstrate compliance with commissioning guidelines. Methods This was a prospective audit carried out over a 12-month period to assess referrals received between March 2019 and February 2020. The participants were all patients referred to the hospital orthodontic department. The index of orthodontic treatment need (IOTN) and index of orthognathic functional treatment need (IOFTN) were recorded, and an evaluation of treatment complexity was made according to current commissioning guidance. The standard set was that ≥80% of patients accepted for treatment should be complexity level 3b. Results A total of 610 patients were seen, with 597 referrals included in the dataset. Thirteen referrals (2%) were excluded owing to missing information. Just under two-thirds (60%) of referrals came from specialist orthodontists in practice, 34% from general dental practitioners, 3% from community dental services and 3% from other hospitals. Over half (56%) were IOTN grade 5, 32% were grade 4, 9% were grade 3 and 3% were grade 2. The majority (79%) of cases met complexity level 3b, 18% were level 3a and 4% were level 2. Overall, 33% were accepted for secondary care and 96% of these met complexity level 3b with 4% at level 3a. Conclusions The gold standard for case acceptance in secondary care was met. This audit demonstrates that cases of appropriate complexity are being accepted for treatment in our department, including training cases for specialty trainees.