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

Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland
D M HemingwayLeicester Colorectal Specialist Interest Group Project Steering Committee

Abstract

To decrease waiting times for colorectal cancer diagnosis. Following extensive negotiations on three sites, we replaced the standard referral route of GP to outpatient clinic with city-wide implementation of a protocol driven sequence based on the patient's declared symptoms, the initial consultation being replaced by the first test taking place within 31 days. No choice in test allocation was granted; difficult cases were adjudicated by named consultants. We used a 'dry run' to make sure that our planned changes would not overload our local capacity, leading to a pilot run involving 1/3 clinicians, followed by a full cross-city implementation over two months. In 2001, before the pilot only 116/188 (62%) of our colorectal cancers who were referred either under the 2-week-wait arrangements or on a 'soon' basis were diagnosed within 31 days of referral. Our 'dry run' established that we did have the capacity to service our planned sequence of tests. In the pilot, all colorectal cancers were diagnosed within 31 days of referral, and 95% of all diagnoses (no abnormality or benign disease) were reached within 31 days of referral. After full implementation 19/19 (100%) of our cancers coming through our protocol system were diagnosed ...Continue Reading

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Citations

Nov 22, 2007·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·T M HammondP J Lunniss
Jul 16, 2008·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·O OdofinG Branagan
Jan 1, 2010·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·M J Kelly, T Cook
Jan 1, 2010·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·S MukherjeeUNKNOWN Homerton Hospital Colorectal Cancer Multidisciplinary Team
May 12, 2010·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·R S Y WuT H Rainer
Jun 22, 2011·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·O AndersonT Bates
Sep 17, 2011·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·A C CurrieR I Swift
Feb 15, 2007·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·S Rai, M J Kelly
Mar 19, 2014·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·C R HitchinsM R McFall
May 7, 2015·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·D G CouchD M Hemingway
Feb 5, 2011·Digestive Surgery·Victor M W T KlemannJoop L M Konsten
Apr 14, 2010·Journal of the National Cancer Institute. Monographs·Larissa Nekhlyudov, Steven Latosinsky
Dec 3, 2014·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Lindsay BlankMelanie Rimmer
Jan 16, 2008·The British Journal of Surgery·S K P JohnJ B J Fozard
Sep 27, 2018·Occupational and Environmental Medicine·UNKNOWN International Commission on Occupational Health (ICOH)
Dec 24, 2008·Annals of the Royal College of Surgeons of England·M M AljarabahJ M D Wheeler
Dec 5, 2013·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·T J RoyleS Bhalerao
Mar 28, 2017·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·A BanerjeaUNKNOWN Nottingham Colorectal Service
Dec 24, 2018·BMC Health Services Research·James Greenwood-LeeDeborah A Marshall
Nov 12, 2020·BMJ : British Medical Journal·Michael ThompsonBrendan Moran
Oct 20, 2020·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·Alex SagarBarrie D Keeler

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