It is well documented that survival of CRC is dependent on early diagnosis. In England, the Department of Health’s cancer policy states that patients with symptoms of suspected cancer must be seen and assessed by the specialist team within 2 weeks of a referral by their General Practitioner (GP). The traditional 2 week wait (2ww) referral route involves these patients being seen in clinic within 2 weeks, where they are assessed and an investigation is booked, taking up to 4 weeks for first investigation and diagnosis. We have introduced a novel Straight to Test / CTAP for these patients, which rationalises the patient journey, ensuring that the patient has the right test first time, without delay.
Our service is a Consultant Nurse led Straight to Test / CTAP. All 2ww patients referred by the GP with suspected CRC are assessed via the CTAP. Upon receipt of the electronic referral from their GP, a colorectal assessment is carried out via telephone within 48 hours of referral by the Consultant nurse or a member or her specialist nursing team. The patient is then triaged for the most appropriate investigation, according to a protocol, which is then booked within 2 weeks of the GPs referral.
The CTAP has been running now for 5 years with over 4000 patients being assessed via this route. In 2017 & 2018 the cancer yield from our service was 4% which matches that of traditional out-patient assessments routes. However we were able to reduce the patient pathway by 10 days by the introduction of the CTAP. 70% of patients had an endoscopy procedure as their first investigation and 28% had a radiological investigation (usually CT Colonography). 90% of patients had their diagnosis or given the all clear by day 14.
This pathway has significantly shortened the patient’s pathway and time diagnosis for our patients, meaning that those patients with CRC are diagnosed by day 14. Patients with other pathologies are also diagnosed quicker and those patients with no serious pathology are reassured and discharged back to their GP We have managed to reduce waiting times from referral to diagnosis and to ensure all patients on the 2ww pathway have a more streamline patient focused experience, avoiding unnecessary hospital visits.
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