An Oral Medicine Update for General Medical Practitioners: A Quality Improvement Project of the Oral Medicine Referral Pathway

AIM:To improve the quality of Oral Medicine referrals received from General Medical Practitioners (GMPs) over a 12 month period.

OBJECTIVES:
To increase GMP awareness of common oral conditions and improve understanding of how to make a high-quality oral medicine referral.
To specifically see an improvement in GMPs:
– appropriately describing oral lesions
– identifying oral cancer risk factors
– completing preliminary special investigations/treatment
– suggesting a provisional diagnosis
– including clinical photographs
– using correct referral grading pathway

SITE:
Oral Medicine Department, Royal Victoria Hospital, Belfast

DISCUSSION:
Baseline data collection (n=50) over three-month period in 2022 to assess referral quality. >80% of referrals included oral cancer risk factors and were sent on appropriate pathway (routine, urgent, red flag). 48% included lesion description, 54% special investigations/treatment and 6% attached clinical photographs. An oral medicine update was delivered to GMPs as a webinar in October 2022 via GPNI- a multi-disciplinary group aiming to distribute clinical updates to primary care practitioners. The webinar has been viewed 139 times, 95% of viewers are GMPs. Salient findings from data recollection (n=50) January – March 2023 include a 36% increase in GMPs describing oral lesions and 12% increase in referrals requiring consultant downgrading. There was no improvement in clinical photograph inclusion. These findings suggest improvement in GMP awareness of oral medicine lesions but may also imply an increase in over cautious referring, perhaps due to increased awareness of oral cancer presentation amongst GMPs. A guide for making an oral medicine referral will be disseminated to GMPs in poster format by April 2024 and referrals reaudited.