RNTNE Voice Therapy Priority rating system-Fastrack or routine, how do you justify your decision?

Philippa C. Ratcliffe

The need was identified, for the use of a systematic approach, based on objective data, with clear prioritisation criteria, monitoring and controls in triaging referrals.
A study of the evidence, on which, decisions of patient allocation to routine or urgent appointments are currently based revealed the use of the Vocal Handicap Index (VHI) , Perceptual evaluation, Case history, and Laryngeal status as criteria for prioritisation.
There are often discepancies however between the these criteria .
The RNTNE Hospital Developed a priority rating systemin 2003 modified over last 3 years.
The Parameters include a combination of VHI, Severity of Dysphonia as described by the surgeon, Status of the larynx, Occupation (taking in to account vocal load) and planned surgery.
Scores are attached to Severity of Dysphonia and a representative spread of laryngeal diagnoses, occupations (taking into account vocal load) and planned surgery.
Scores range from 1 to 3 on each parameter, the final score can total from 0 to 15.
To be fast tracked and given an urgent appointment a score of 10 is needed.
The system is monitored and any breaches are investigated and the scoring system can be further refined.
As a result the numbers of urgent appointments have reduced and are kept at a constant level, resulting in a significant reduction in waiting time.
The Priority System is extremely robust, has built in monitoring controls and is replicable.

Philippa C.Ratcliffe
Principal Speech and Language Therapist
Speech Therapy (ENT)
The Royal National Throat Nose and Ear Hospital
Grays Inn Rd
London WC1X 8DA
020 7915 1480