The appropriateness of referrals for exodontia in children under general anaesthetic

Abstract

Objective To analyse the appropriateness of referrals received by Salford Primary Care Trust (PCT) for general anaesthetic (GA) extractions. To assess the adherence to General Dental Council (GDC) and Salford PCT guidelines. Methods A data collection form was completed for all patients who attended the GA assessment clinics over a three month period in 2006. Results Sixty-one referrals in total were assessed. Ninety-seven per cent of the 61 referrals received adhered to the Salford PCT proforma requirements, with only 33 per cent complying with GDC guidelines. Gross caries was cited as the major reason for referral (90%) of cases. Justification was given for GA in 97 per cent of cases. Major reasons cited were anxiety and multiple extractions in more than one quadrant. Twenty-one per cent of referrals were considered inappropriate. In only 18 per cent of cases did the specialist treatment plan correlate with the treatment requested. Conclusions There are a high number of inappropriate referrals received by Salford PCT, showing a severe deficiency in the adherence to GDC guidelines by general dental practitioners, particularly in discussion of the risks involved and in the dental history. There was a low correlation between the specialist treatment plan and treatment requested, showing a lack of understanding by the referring dentists of the service provided under GA. Suggested strategies to improve the referral system are: • Send referring dentists a copy of GDC guidelines and Salford PCT referral criteria • Return all inappropriate referrals back to the referring dentist, highlighting the deficiency on the letter/proforma • Education of local dentists in GA treatment planning for children and health promotion