What approach should be taken to manage the increased referrals to the Oral and Maxillofacial Surgery (OMFS) department observed post-COVID compared to pre-COVID periods?

Managing Increased Two-Week Wait (2WW) Referrals to OMFS Post-COVID

The OMFS department at RCHT should acknowledge the documented increase in 2WW referrals post-COVID as part of a broader healthcare phenomenon, implement triage protocols with remote assessment capabilities, and establish clear prioritization criteria to manage the backlog while maintaining cancer detection standards.

Context of Increased Referrals Post-COVID

The increase in 2WW referrals to OMFS at RCHT reflects a well-documented pattern across surgical specialties following the COVID-19 pandemic. Multiple factors have contributed to this surge:

• Delayed presentations during lockdowns: Patients avoided healthcare facilities during peak pandemic periods, leading to accumulated cases that now require urgent assessment 1
• Backlog from suspended services: Most surgical departments suspended elective procedures and limited ambulatory visits by mid-March 2020, creating a significant backlog of cases requiring evaluation 2
• Increased disease severity: The lack of routine check-ups and delayed presentations has likely resulted in more advanced disease stages at diagnosis, potentially increasing the proportion requiring urgent specialist review 1

Recommended Management Approach

Triage and Remote Assessment Integration

Implement a hybrid triage system combining telephone consultations with face-to-face assessments for appropriate cases:

• Initial telephone triage demonstrates high patient satisfaction (83.48% willing to use telephone consultations in future) and can efficiently stratify referrals 3
• Remote consultations successfully managed 59.5% of cases requiring further review and discharged 29.3% without face-to-face contact in OMFS settings 4
• However, diagnostic accuracy concerns were noted in 43.5% of qualitative comments, highlighting the need for careful patient selection for remote assessment 4

Prioritization Framework

Establish clear criteria for urgent versus deferrable assessments:

• High-priority cases (suspected malignancy with red flags) should receive expedited face-to-face assessment within 2WW timeframes 5
• Intermediate-priority cases may be suitable for initial telephone assessment followed by face-to-face review if indicated 4
• Review patients demonstrate higher compliance with telephone consultations compared to new patients (p=0.004), suggesting this modality is better suited for follow-up rather than initial cancer assessments 3

Resource Optimization

Adapt staffing and clinic structures to handle increased volume:

• Consider implementing rotating team approaches to prevent staff burnout and maintain service continuity, as successfully employed in other surgical departments during the pandemic 5
• Utilize virtual multidisciplinary team meetings to efficiently review complex cases and determine appropriate management pathways 5
• Leverage telemedicine platforms (40% of OMFS programs successfully implemented these during early pandemic) for appropriate consultations 2

Critical Pitfalls to Avoid

• Do not rely solely on remote assessment for new 2WW referrals: New patients showed lower compliance levels with telephone consultations, and diagnostic accuracy concerns are significant for cancer detection 3, 4
• Avoid delaying face-to-face assessment when clinical examination is essential: 43.5% of remote consultations identified diagnostic limitations due to inability to perform traditional examination 4
• Do not underestimate the psychological impact on staff: Only 73% of OMFS programs had adequate resources for resident wellness during the pandemic, highlighting the need for staff support during high-volume periods 2

Documentation and Quality Assurance

• Document pandemic-related service modifications in patient records to facilitate future quality assessment and understand long-term impacts of altered care pathways 5
• Monitor conversion rates from telephone to face-to-face consultations and cancer detection rates to ensure quality standards are maintained 4
• Track time-to-diagnosis metrics to identify any delays in cancer detection resulting from increased referral volumes 1