P171 A Local Cancer Network Root Cause Audit of 62-day Lung Cancer Pathway Breaches

Abstract

IntroductionOver several years there has been an ongoing rise in 62-day Lung Cancer pathway referrals initiated by GPs as two-week wait referrals (2WW). This was particularly marked in 2014 and breach rates increased across the East of England SCN. Within the Essex Lung Cancer Network an audit of these breaches was undertaken by three Trusts to look for common themes and to share best practice.MethodsData were collected for all pathways that failed to meet the 62-day target across three NHS Trusts in Essex to identify any predictive factors for breaching the pathway. A standard proforma was used for abstraction. Results were analysed using GraphPad Prism 6 (La Jolla, CA).ResultsIn 2014 a total of 1,419 2WW referrals were received by the three Trusts of which 13–23% were diagnosed with lung cancer. Between 19% and 54% breached the 62-day target (89 of 246 pathways). The median length of the breached pathways varied from 86–88 days by Trust. Trusts did not appear to differ significantly by end treatment after pathway breach. There were generic common themes within the breached pathways of each Trust but for the two worst performing Trusts specific pathway issues were identified. In one Trust it was clear that time delays to perform CT guided lung biopsies with a 2.75 relative risk of breaching if a pathway involved a CT biopsy (95% CI 1.6–4.6, p < 0.0001). At another Trust a high proportion of breached pathways had a bronchoscopy as the first test but went on to have further diagnostic biopsies by other methods.ConclusionMany of the diagnostic delays were due to complex patient pathways needing multiple diagnostic tests. However for two Trusts significant problems were highlighted for targeted quality improvement plans. Selecting the best test to give diagnostic and staging information is vital particularly when services are stretched and capacity is reached.