Ear, nose and throat emergency clinic services vary greatly between trusts. Their common aim is to enable acute conditions to be seen quickly and effectively within an optimum environment. There is however no ‘gold standard’ for service.

To identify an efficient model of service, and to determine whether introduction of a referral and appointment based system improves patient waiting times and appropriateness of referrals.

A prospective audit, comprising: an initial survey to appraise the existing service; telephone surveys of eight trusts in the West Midlands to determine variability of ENT emergency clinic services and to identify components of an effective service; and re-audit following implementation of a verbal referral and appointment based service.

The new service significantly reduced patient waiting times, from 70 minutes to 35 minutes (t = 6.776; p < 0.01), with an associated reduction in the variability of waiting times. Inappropriate referrals were reduced from 7 to 2 per cent. These results were achieved when a 72 per cent referrer compliance with the service was observed.

A verbal referral and appointment based system improves patient waiting times and appropriateness of referrals. Maintenance of high referrer compliance with such a system should be considered, and a tool for monitoring referring practitioners is suggested. This clinic construct model is offered as an example in order to aid delivery of an effective ENT emergency service in departments with similar patient demand and staff resources.