Straight to test: introduction of a city‐wide protocol driven investigation of suspected colorectal cancer

Dm, Hemingway; Jameson, J. S.; Kelly, Maggi

doi:10.1111/j.1463-1318.2005.00935.x

Cited by 29 publications

(43 citation statements)

References 8 publications

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“…In 2005, Hemingway et al 12 published the results of a city-wide, protocol-driven investigation of suspected colorectal cancer. In their approach, they replaced the standard referral route of GPs to out-patient clinic with a protocol-driven investigation where, for each symptom or symptom group in their new proforma, a test or tests were allocated to be booked directly by the administration staff; patients with palpable rectal mass were allocated to an outpatient appointment first.…”

Section: Discussionmentioning

confidence: 99%

Referral Letters for 2-Week Wait Suspected Colorectal Cancer do not Allow a ‘Straight-to-Test’ Pathway

Aljarabah

Borley

Goodman

et al. 2009

annals

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INTRODUCTION Some clinicians have argued that 2-week wait suspected colorectal cancer patients can go 'straight-to-test' to facilitate time to diagnosis and treatment. The aim of this study was to evaluate whether the currently used referral letters are reliable enough to allow that pathway. PATIENTS AND METHODS General practitioner (GP) letters referring patients under the Two Week-Wait Rule for suspected colorectal cancer were prospectively reviewed over a 6-month period. Three examining consultants were asked to outline the tests they would perform having only read the letter, and then again after a clinical consultation with the patient. The outcome of these tests was tracked. RESULTS A total of 217 referral letters of patients referred under Two Week Wait Rule for suspected colorectal cancer were studied. Having just read the referral letter, the most frequently requested test was colonoscopy (148), then CT scan (48), barium enema (44), followed by gastroscopy (23) and flexible sigmoidoscopy in 15 patients (some patients would have had more than one test requested). After consultation with the patients, tests requested as guided by the GP letter were changed in 67 patients (31%), where 142 colonoscopies, 61 CT scans, 37 barium enemas, 23 flexible sigmoidoscopies and 19 gastroscopies were organised. The referral indication which had tests changed most often was definite palpable rectal mass (67%), while patients referred with definite palpable right-sided abdominal mass had their tests least often changed (9%). A total of 22 patients were found to have colorectal cancers (10%) and 30 patients were diagnosed with polyps (14%). Out of 142 colonoscopies performed, 19 (13%) showed some pathology beyond the sigmoid colon and of the 23 patients who had flexible sigmoidoscopy initially, only three went on to have colonoscopy subsequently. During the 6-month period of the study, only five breaches of the waiting time targets were recorded (1 to the 31-day target and 4 to the 62-day target). CONCLUSIONS A significant number of patients would have had tests changed after a clinical consultation. However, only a small number required further investigations having had a consultation prior to their initial investigations. We conclude that 2-week wait suspected colorectal cancer patients should be seen in the clinic first and should not proceed 'straight-to-test'.

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Section: Discussionmentioning

confidence: 99%

Referral Letters for 2-Week Wait Suspected Colorectal Cancer do not Allow a ‘Straight-to-Test’ Pathway

Aljarabah

Borley

Goodman

et al. 2009

annals

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“…Of the 140 interventions, the majority were conducted in the UK (n = 82 18,19,[21][22][23]26,28,[30][31][32]34,37,38,64,65,68,70,71,73,74,[76][77][78][79][80][82][83][84][85]94,96,99,103,104,106,109,114,116,117,119,122,[124][125][126]128,129,131,133,139,140,142,143,[152][153][154][155][156][157]159,160 ) or the USA (n = 20 …”

Section: Populations and Settingsmentioning

confidence: 99%

What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis

Blank

Baxter

Woods

et al. 2015

Health Services and Delivery Research

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BackgroundDemand management describes any method used to monitor, direct or regulate patient referrals. Several strategies have been developed to manage the referral of patients to secondary care, with interventions targeting primary care, specialist services, or infrastructure.ObjectiveThis research aimed to conduct an inclusive systematic review and logic model synthesis in order to better understand factors impacting on the effectiveness of interventions targeting referral between primary and secondary medical health care.DesignThe approach combined systematic review with logic modelling synthesis techniques to develop an evidence-based framework of factors influencing the pathway between interventions and system-wide changes.SettingPrimary health care.Main outcome measuresReferral from primary to secondary care.Review methodsSystematic searches were undertaken to identify recent, relevant studies. Quality of individual studies was appraised, with consideration of overall strength of evidence. A narrative synthesis and logic model summary of the data was completed.ResultsFrom a database of 8327 unique papers, 290 were included in the review. The intervention studies were grouped into four categories of education interventions (n = 50); process change interventions (n = 49); system change interventions (n = 38); and patient-focused interventions (n = 3). Effectiveness was assessed variously in these papers; however, there was a gap regarding the mechanisms whereby these interventions lead to demand management impacts. The findings suggest that, although individual-level interventions may be popular, the stronger evidence relates only to peer-review and feedback interventions. Process change interventions appeared to be more effective when the change resulted in the specialist being provided with more or better quality information about the patient. System changes including the community provision of specialist services by general practitioners, outreach provision by specialists and the return of inappropriate referrals appeared to have evidence of effect. The pathway whereby interventions might lead to service-wide impact was complex, with multiple factors potentially acting as barriers or facilitators to the change process. Factors related, first, to the doctor (including knowledge, attitudes and beliefs, and previous experiences of a service), second, to the patient (including condition and social factors) and, third, to the influence of the doctor–patient relationship. We also identified a number of potentially influential factors at a local level, such as perceived waiting times and the availability of a specialist. These elements are key factors in the pathway between an intervention and intended demand management outcomes influencing both applicability and effectiveness.ConclusionsThe findings highlight the complexity of the referral process and multiple elements that will impact on intervention outcomes and applicability to a local area. Any interventions seeking to change referral practice need to address factors relating to the individual practitioner, the patient and also the situation in which the referral is taking place. These conclusions apply especially to referral management in a UK context where this whole range of factors/issues lies well within the remit of the NHS. This work highlights that intermediate outcomes are important in the referral pathway. It is recommended that researchers include measure of these intermediate outcomes in their evaluation of intervention effectiveness in order to determine where blocks to or facilitators of system-wide impact may be occurring.Study registrationThe study is registered as PROSPERO CRD42013004037.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Monitoring for adherence with guidelines and subsequent improvements in the desired outcomes is needed (50)(51)(52)(53). It is important to note that the same guideline may not work in different health-care settings (13,54); thus, success requires careful planning, implementation, and evaluation within a given system (55).…”

Section: From a Survivormentioning

confidence: 99%

The Interface of Primary and Oncology Specialty Care: From Symptoms to Diagnosis

Nekhlyudov

Latosinsky

2010

JNCI Monographs

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Straight to test: introduction of a city‐wide protocol driven investigation of suspected colorectal cancer

Cited by 29 publications

References 8 publications

Referral Letters for 2-Week Wait Suspected Colorectal Cancer do not Allow a ‘Straight-to-Test’ Pathway

Referral Letters for 2-Week Wait Suspected Colorectal Cancer do not Allow a ‘Straight-to-Test’ Pathway

What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis

The Interface of Primary and Oncology Specialty Care: From Symptoms to Diagnosis

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