Kapoor, N.; Bassi, A.; Sturgess, R.; Bodger, K.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA89
Academic Journal
Background: The NHS 2 week rule requires rapid evaluation of patients with suspected upper Gl cancer based on the presence of pre-determined alarm features. We report a single centre experience of implementing a RAUGICS in a university hospital serving a population of 330 000. Methods: Details of all referrals to the RAUGICS were recorded prospectively on a dedicated database, including demographics, referral indications (from standard referral proforma), OGD results, and outcome. DNA rates (failure to attend) were also monitored. Accuracy of GP stated referral criteria were verified by selfadministered symptom questionnaire in a sample of patients. Results: Predictive value of referral criteria for cancer (18 month data; 1852 patients; mean age 59 years; cancer yield: 3.8%): Logistic regression analysis revealed that dysphagia (OR 3.1), weight loss (OR 2.6) and age > 55 years (OR 9.5) were significant predictors of cancer, whereas so-called "high-risk dyspepsia" had negative predictive value within this cohort (OR 0.1). Workload data (12 month period): 1207 patients were referred. All initial non-attenders were sent a 2nd appointment, hence 1462 slots (121% of referral numbers) were allocated. 1137 patients (94.2%) altended for OGD (74% being undertaken by nurse endoscopists). There were 53 cases of cancer (yield: 4.6%). Of 1030 patients who were allocated a follow up clinic appointment after OGD, 240 (23%) failed to attend. The presence of significant pathology at OGD did not influence subsequent clinic DNA rate (serious disease: 20% vs normal OGD: 24%). GP stated referral criteria: symptom questionnaires confirmed the presence of designated alarm features in 97% of patients (n = 65). Conclusions: Despite effectively targeting rapid access diagnosis to a high risk population for cancer (4.6% prevalence), the high workload of our RAUGICS is compounded by a DNA rate of 21%, with similar levels of non-attendance at the follow up clinic. Application of narrower...


Related Articles

  • AUDIT OF THE 2 WEEK RULE (TWR) FOR SUSPECTED UPPER GASTROINTESTINAL (UGI) CANCER AND THE PATHWAYS TO DIAGNOSIS. Barbour, J.; Leontiadis, G.; Saeed, A.; Kadis, S. // Gut;Apr2003 Supplement 1, Vol. 52, pA88 

    Aims: To audit TWR for UGI cancers in a north east district general hospital (DGH) and to determine the proportion of UGI cancers diagnosed outside the TWR referral system. Methods: Prospective audit of all TWR over a 20 week period (Oct 2001 to March 2002) in our DGH (catchment population...

  • THE 2 WEEK STANDARD FOR SUSPECTED UPPER GI CANCERS: ITS IMPACT ON CANCER STAGING. Radbourne, D.; Walker, G.; Joshi, D.; Sheil, M.; Robertson, F.; Steger, A.; O'Donohue, J. // Gut;Apr2003 Supplement 1, Vol. 52, pA116 

    Introduction: The 2 week wait standard for suspected upper Gl cancer ('the standard'), introduced 1 July 2000, requires patients to be seen by a specialist within 2 weeks of referral. We aimed to investigate its impact on the pattern of referrals and clinical outcome. Methods: We identified...

  • GI Ca guide cuts referrral 40%. Wilkinson, Emma // Pulse;3/23/2006, Vol. 66 Issue 12, p7 

    The article reports on the findings of a study revealing that a new risk score in Great Britain could reduce general practitioner referrals for upper gastrointestinal cancer by 40 percent. The scoring system applies additional criteria on top of the National Institute for Clinical Excellence...

  • Dyspepsia referral: Is NICE right or wrong? Goddard, Andrew // Pulse;5/14/2005, Vol. 65 Issue 19, p56 

    Examines guidelines issued by the National Institute of Clinical Excellence (NICE) in Great Britain on dyspepsia management. Discrepancies between NICE and national cancer referral guidelines; Guidelines for the primary care management of dyspepsia in adults; Guidelines for urgent referral for...

  • Beware: You can be liable for a referral gone awry. Stout, Chris E. // Psychotherapy Letter;Jun96, Vol. 8 Issue 6, p7 

    Focuses on the possible liability of doctors when making a medical referral. Safeguarding against the risks; Maintenance of the standard of care.

  • Don't let referrals go sour. Murray, Dennis // Medical Economics;8/7/95, Vol. 72 Issue 15, p113 

    Offers advice for doctors on how to resolve referral conflicts. Right of primary-care physicians to keep abreast with patient's treatment; Diplomacy; Presentation of a united front; `Team approach'; Non-reliance to patient's word; Patient's conflicting histories; Communication; Patient's final...

  • Positively productive PPO prospecting. Bernstein, Alan L. // ENT: Ear, Nose & Throat Journal;Jan1996, Vol. 75 Issue 1, p52 

    Editorial. Looks at ways to promote an increase in new patients. Reference to the `Practice Builder.'

  • How to protect existing referral relationships against marauders. Bernstein, Alan L. // ENT: Ear, Nose & Throat Journal;Feb96, Vol. 75 Issue 2, p109 

    Offers advice on how to protect existing referral relationships against competitors. Importance of ongoing maintenance.

  • Recruiting non-referring professionals through their non-referred clientele. Bernstein, Alan L. // ENT: Ear, Nose & Throat Journal;Mar1996, Vol. 75 Issue 3, p174 

    Discusses the recruitment of non-referring professionals through non-referred clientele. Recruitment method used.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics