# A Completed Cycle Audit of a Tongue-Tie Management Pathway for Newborns

## TL;DR

This study evaluates a referral pathway for tongue-tie in newborns, showing improved effectiveness and accuracy over time.

## Contribution

The study completes a second-cycle audit, demonstrating the pathway's impact on referral appropriateness and intervention rates.

## Key findings

- 73.2% of referrals included a completed proforma in the final cycle.
- Frenulotomy rates increased from 53% to 95.9% after pathway implementation.
- Referral appropriateness and correlation with clinic findings improved significantly.

## Abstract

Introduction: Tongue-tie (ankyloglossia) can cause significant feeding difficulties in infants. A quality improvement project conducted in 2015-2016 at our centre led to the introduction of a referral pathway that standardised frenulotomy (tongue-tie release) services. This project completes a second-cycle audit to evaluate the appropriateness and effectiveness of the tongue-tie referral pathway for patients under three months old.

Methods: A retrospective case-note review was conducted on 310 patients referred for tongue-tie assessment between January 2019 and December 2023. Data were collected from hard copies and electronic patient records. Parameters assessed included referral source, use of the proforma, use of the Bristol Tongue Assessment Tool (BTAT), and whether division was performed.

Discussion: In the final project cycle, 73.2% of tongue-tie referrals included a completed proforma. The number of patients undergoing frenulotomy increased from 53% prior to the pathway to 61% in the first cycle and then to 95.9% in the final cycle. There is an increase in referral appropriateness and in the correlation between referral indications and ENT clinic findings. A total of 10% of referrals lacked an attached clinical letter, and alternative or incomplete referral methods were still occasionally used. General practitioners (GPs) and advanced nurse practitioners (ANPs) were more likely to refer via the alternative systems rather than through the pathway.

Conclusion: The completed project confirms the effectiveness and appropriateness of the tongue-tie referral pathway, leading to more accurate referrals and higher intervention rates. Scope for improvement could include future updates of the proforma and providing further education to community referrers. Future reviews and integration with electronic systems and implementation of One Devon may enhance consistency and long-term sustainability.