Straight to CT delivers earlier first definitive treatment

Published Date: 16th May 2017

Publication Authors: Malhotra P, Murphy P, Dawson C, Hunt N, Hendry J

Background 

The National Optimal Lung Cancer Pathway (NOLCP) recommends performing a CT scan before a patients first appointment in a rapid access suspected lung cancer clinic. A local audit in 2014 at our hospital which receives over 350 two week rule suspected lung cancer referrals per year found that less than 50% of patients had a CT scan before their first appointment.

Objective 

To determine the effect of a simple cue for physicians stamped on 2 week rule referral forms on the proportion of patients who have a CT scan before their first appointment in a rapid access suspected lung cancer clinic, and its effect on the time to definitive treatment.

Methods 

This was a retrospective analysis of the lung cancer clinic database at a large district general hospital. Two periods were audited: September – November 2014 (pre-intervention), and July – September 2015 (post-intervention). Data on demographic characteristics, date of first clinic, date of performance of CT scan, and time to definitive treatment was collected. From January 2016 onwards, a simple new intervention was put in place: all 2 week rule referrals were stamped with a cue (“Pre-clinic CT: Yes or No?”) for Consultants triaging the referral to prompt them to arrange a pre-clinic CT scan if appropriate. Re-audit was carried out during the period July–September 2015.

Results 

Seventy-six out of 81 two week rule referrals between September–November 2014 had a CT scan during their management pathway. Thirty-six (47%) of these scans were performed before the patients first appointment in clinic. Re-audit between July-September 2015 after introduction of the stamp revealed that 88 CT scans were performed on 101 two week referrals. Of these, 70 (80%) patients had a CT scan before their first appointment.

Time to first definitive treatment improved by 1 week from 38.7 days in the pre-intervention cohort, to 31.5 days in the post-intervention cohort.

Conclusion 

A simple cue stamped on 2 week rule referral forms increased the proportion of patients who had a CT scan before their first appointment in a rapid access suspected lung cancer clinic from 47% to 80%, and reduced the time to definitive treatment by 1 week.

Malhotra, P; Murphy, P; Dawson, C; Hunt, N; Hendry, J. (2016). P81 Straight to CT delivers earlier first definitive treatment in lung cancer– effect of a simple intervention . Thorax. 71 (Suppl 3), A128.

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