TITLE

THE 'TWO WEEK RULE' (2WR) DIRECTIVE: GOOD OR BAD POLITICS FOR PATIENTS?

AUTHOR(S)
Douglass, A.; Agarwal, A.; Wilson, R.G.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA26
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Introduction: The 2wr directive for Gl malignancies, suspected by GPs, purports to enhance and accelerate diagnosis and care. The imperative is to "see" the patient within 2 weeks, whereas the relevant first key clinical step is to confirm or refute the diagnosis for all potential cases. This is optimised by fast tracking to definitive investigation—usually endoscopy. If resources do not allow for this within 2 weeks, urgent clinic slots are taken up mostly just to explain the need for that test. No evidence base shows this approach as helpful overall and perhaps it disadvantages a significant proportion of patients. Aims and Objectives: We determined the potential number of 2wr referrals out of all colorectal referrals received (catchment 300 K). We also established the proportion of actual colorectal cancer (CRC) cases that would not have fulfilled the national 2wr criteria. Methods: All (medical and surgical-clinic and open access) referrals to our unit in an 8 week period and all CRC cases diagnosed in a 1 year period were reviewed. Results: Referral audit: 773 referrals total (86 excluded— insufficient data in referral). 248 fulfilled the 2wr criteria and were referred via open access colonoscopy (87) and clinic (161), representing 48% and 32% of all such referrals, respectively. Only 8% were actually referred by 2wr—a further 18% were assigned other degrees of urgency by the GP. 248 in 8 weeks is ∼30/week. If 20 min is allowed per 2wr clinic slot, this amounts to 10 h/week even before diagnosis is organised for most. (The impact for upper Gl cases could be similar). CRC Audit: 178 CRC cases total, 46 presented acutely. 33 (25% of non-acute) did not fulfil 2wr criteria (Dukes A and B 53%), the remainder did (A and B 52%). Conclusions: Many CRC cases do not fulfil 2wr referral criteria but have similar staging. If the 2wr was strictly adhered to in primary care, these face potential disadvantage in timely attention. Furthermore, clinic...
ACCESSION #
9747430

 

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