# Audit of Nasal Bone Fracture Referrals to an ENT Hub: Timeliness of Review and Management

## TL;DR

This audit assesses how quickly nasal bone fracture referrals are reviewed and managed at an ENT hub, finding delays in contacting patients and managing pediatric cases.

## Contribution

The study introduces a novel audit of referral timeliness for nasal bone fractures in an ENT hub, highlighting delays and proposing improvements.

## Key findings

- Telephone triage reduced clinic attendances by 39%.
- Only 63% of referrals were contacted within seven days of referral.
- All three pediatric patients requiring nasal bone manipulation were managed outside the 14-day window.

## Abstract

Introduction: Nasal bone fractures (NBFs) are among the most common facial injuries and often require prompt evaluation and intervention to optimise functional and cosmetic outcomes. This audit evaluates the timeliness of review and management for patients referred to an ENT hub via email.

Methods: A retrospective review was conducted of all referrals to the ENT hub email at Ulster Hospital, Dundonald, between January 1, 2022, and March 18, 2022. All suspected NBF referrals were included. Data on demographics, time intervals from injury to referral, referral to review, and time to manipulation of nasal bones (MNB) were collected.

Results: Fifty-six referrals were identified (age range: 7-89 years). All patients were contacted via telephone triage, which reduced clinic attendances by 39%. Ninety-three percent of referrals were received within seven days of injury; however, only 63% were contacted within seven days of referral. Of the 34 patients reviewed in clinic, 82% were seen within two weeks of injury. Nineteen patients underwent MNB, with 68% receiving intervention within 14 days. All three paediatric patients requiring MNB were managed outside the 14-day window due to theatre delays.

Conclusion: Telephone triage effectively reduced unnecessary clinic reviews, but delays in contacting patients, particularly paediatric cases, affected timely management. Earlier in-clinic review for children, better communication strategies, and ensuring accurate referral information may improve service delivery.