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...


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