Introduction/Background The UK National Institute for Health and Care of Excellence(NICE) has published guidance for suspected cancer referrals to help Primary Care doctors refer patients for further investigations. The threshold cancer probability for referral is set at 3%. Patients are then seen in rapid access clinics(RAC) in Secondary Care. Unfortunately, many referrals are inappropriate and this creates a burden in secondary care. These referrals also cause unnecessary anxiety to the patients. To improve the efficacy and effectiveness of the RAC, we identify inappropriate referrals and manage these patients in an alternative pathway. We provide timely feedback and education for staff working in Primary Care. Standardised letters have been developed for each type of inappropriate referral, which are sent to both the patient and the referring doctor.
Methodology A retrospective analysis of all suspected cancer referral forms sent to our unit between May 1st 2021 and April 31st 2022 was performed.
Results A total number of 958 suspected cancer referrals were made to our unit within the period of 12 months. These were triaged by a senior gynaecologist and 28% were deemed inappropriate. Of these inappropriate referrals, 15% were for suspicion of endometrial cancer, 7% were for ovarian cancer and 6% were for cervical, vulval and vaginal cancers grouped together.Breakthrough bleeding on Hormone Replacement Therapy (HRT) was the most common inappropriate referral (n=81). Other common reasons included: obviously benign lesions of the vulva, vagina and cervix, intermenstrual bleeding, postcoital bleeding, non-suspicious ovarian cysts, endometrial thickening, and isolated elevation of CA125. We have identified Primary Care doctors that are outliers and provided targeted education and training.
Conclusion We have identified common reasons for inappropriate referral and created an alternative pathway for these patients. Targeted education has been provided for Primary Care doctors. These measures have enabled the RAC to function more effectively.
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