481 - Quality Improvement: Tongue Tie Referrals using BTAT at a Maxillofacial Department

L Brooks H Emam S Ananth
Presented by: Laura Brooks
Morriston Hospital

Introduction Infant babies are referred to the Maxillofacial department via a specialist clinical pathway, when a tongue tie is preventing effective breastfeeding. The department noted multiple inappropriate infant tongue tie referrals were being received. Most did not include a BTAT (Bristol Tongue Assessment Tool) score resulting in infants being seen who did not require treatment. Baseline data from May to November 2019 showed from 48 referrals, 16.7% (n=8) had a BTAT score. Of the referrals that used a BTAT score 62.5% (n=5) had a lingual frenectomy compared with 37.5% (n=15) of patients where the BTAT score was not included. Aim: For at least 90% of infant tongue tie referrals to the Maxillofacial department to include a BTAT score by June 2020. Methods Fishbone diagram, stakeholder analysis, a driver diagram and an ease-benefit matrix were all completed to identify the most effective changes. A Pareto chart showed 91.7% of the referrers were infant feeding coordinators (IFCs) and midwives, so they were selected to be the target group. A Plan Do Study Act cycle was then completed. A training session was organised for the local IFCs and midwives in the use of BTAT and what information was required in a referral. They were provided with the necessary illustrated leaflets and printed BTAT scoring forms. A checklist was then emailed to the participants. Further data was then collected for 13 weeks. Results The percentage of referrals using a BTAT score increased from 16.7% to 38.5% (2.3-fold improvement) but did not achieve the intended target (90%) during the first cycle. Conclusion Only one PDSA cycle was conducted due to COVID-19 restrictions on referrals, so further planned changes to the referral pathway have not been yet implemented. The project highlighted that when working in a multidisciplinary team, the use of adequate communication tools is key for the patient to receive the most appropriate treatment and for NHS time and resources not to be wasted.
Consent Statement: There are no details on individual patients reported within the abstract.

Poster Quality Improvement: Tongue Tie Referrals using BTAT at a Maxillofacial Department