Removing hospital-based triage from suspected colorectal cancer pathways: the impact and learning from a primary care-led electronic straight-to-test pathway

Removing hospital-based triage from suspected colorectal cancer pathways: the impact and learning from a primary care-led electronic straight-to-test pathway
BMJ Quality & Safety 11 June 2020. doi: 10.1136/bmjqs-2019-009975

• An electronic straight to test pathway for suspected colorectal cancer was introduced allowing GPs to book tests supported by a decision aid based on NICE guidance eliminating the need for a standard referral form or triage process. 
• Analysis of 11357 patients over 3 years found  that time from referral to diagnosis reduced from 39 to 21 days and led to a dramatic improvement in patients starting treatment within 62 days. Challenges included adapting to a change in referral criteria and developing a robust hospital system to monitor the pathway.

Abstract

Improving colorectal cancer referrals

Improving colorectal cancer referrals
BMJ Open Qual 2018;7:e000280. doi: 10.1136/bmjoq-2017-000280

• This quality improvement project (The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust) focused on sending fast-track colorectal GP referrals through a straight-to-colonoscopy telephone assessment clinic (TAC). 
• The results showed an improvement from GP referral to colonoscopy. Both PDSA cycle 1 and PDSA cycle 2 showed an average of 24 days, a reduction of 6 days. A temporary full-time TAC nurse appointment (PDSA cycle 3) showed a reduction of the average from referral to colonoscopy to 19 days and a reduction in the variation. The TAC role is now a permanent position.