A colorectal straight-to-test cancer pathway with general-practitioner-guided triage improves attainment of the 28-day diagnosis target and increases outpatient clinic capacity.

AIM: This study investigates whether a straight-to-test (STT) colorectal cancer pathway improves attainment of the National Health Service (NHS) England 28-day Faster Diagnosis Standard and the effect of the pathway on reducing face-to-face outpatient clinic appointments. Patient satisfaction and the safety of a novel general practitioner (GP) led patient triage system regarding suitability for colonoscopy are also evaluated. METHODS: This is an observational study of all patients managed via an STT colorectal cancer pathway between 1 September 2019 and 19 March 2020. Comparison is made with all patients referred on the suspected colorectal cancer pathway prior to implementation of the STT pathway from 1 January 2019 to 30 July 2019. Patient satisfaction with the STT pathway was assessed with a telephone-based questionnaire. RESULTS: Attainment of the 28-day diagnosis target for all suspected colorectal cancer referrals improved following the establishment of the STT pathway (88% vs. 82%, P < 0.0001). From a potential total of 548 outpatient colorectal clinic appointments for patients on the STT pathway, 504 (92%) were avoided. In those eligible for the STT pathway, GP assessment of patients suitable for colonoscopy agreed with that of the colorectal department in 93% of cases. Of the 50 patients who undertook the satisfaction survey, 86% were satisfied or very satisfied with the pathway. No patient suffered adverse events as a result of their STT investigations. CONCLUSION: An STT pathway for suspected colorectal cancer referrals with novel GP-led patient triage safely streamlines patients through the suspected colorectal cancer diagnostic pathway and significantly reduces requirement for face-to-face outpatient clinic attendance. This is achieved with high patient satisfaction.

An Orthopaedic Fracture Clinic Service Audit: A Complete Loop.

Introduction The British Orthopaedic Association Standards for Trauma (BOAST) Guideline 7 informs the standard of care patients should expect when they come to orthopaedic fracture clinics in the United Kingdom (UK). Objectives We compared our fracture clinic's practice against the standards set by BOAST Guideline 7 to make changes for aligning with the standard of care. We aimed to then re-audit our practice for further evaluation against the guidelines. Material and methods We prospectively collected data from 100 patients presenting to the fracture clinics of different orthopaedic consultants working in our hospital, using the Royal College of Surgeons in Ireland's (RCSI's) satisfaction with outpatients services (SWOPS) questionnaire. We made some improvements, recommended changes to the hospital management, and conducted a re-audit, collecting data from another 100 patients. Results With reference to improvements, we were only able to make them on behalf of the doctors and clinical auxiliary staff. We were able to decrease the waiting time from a patient's initial presentation in the accident and emergency (A&E) department to an appointment at the fracture clinic. A few improvements were made to the waiting area facilities. However, the cumulative changes resulted in a positive attitude in patient satisfaction levels. Conclusion Considering our complete audit loop, we found gaps and enabled improvements, but areas of concern remain, which will need to be addressed in the future.